Provider Demographics
NPI:1457687519
Name:SAFE HAVEN SKILLED SERVICES, LLC
Entity type:Organization
Organization Name:SAFE HAVEN SKILLED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:CSA, BS
Authorized Official - Phone:717-582-4110
Mailing Address - Street 1:1566 NEW BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17068-8036
Mailing Address - Country:US
Mailing Address - Phone:717-582-9977
Mailing Address - Fax:717-582-4259
Practice Address - Street 1:16 W MAIN ST
Practice Address - Street 2:BOX 755
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:PA
Practice Address - Zip Code:17068-9603
Practice Address - Country:US
Practice Address - Phone:717-582-4110
Practice Address - Fax:717-582-4138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03600501251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03600501OtherSTATE LICENSE NUMBER