Provider Demographics
NPI:1487341459
Name:LURRANAH SAFE HAVEN LLC
Entity type:Organization
Organization Name:LURRANAH SAFE HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTIQUE
Authorized Official - Middle Name:LASEAN
Authorized Official - Last Name:DORTCH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:313-870-8736
Mailing Address - Street 1:39449 DELLA ROSA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39449 DELLA ROSA DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-5227
Practice Address - Country:US
Practice Address - Phone:313-870-8736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care