Provider Demographics
NPI:1548644503
Name:SAFEAVEN, LLC
Entity type:Organization
Organization Name:SAFEAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUDENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-289-1439
Mailing Address - Street 1:5028 34TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2116
Mailing Address - Country:US
Mailing Address - Phone:727-289-1439
Mailing Address - Fax:727-289-1439
Practice Address - Street 1:5028 34TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2116
Practice Address - Country:US
Practice Address - Phone:727-289-1439
Practice Address - Fax:727-289-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
FL6906786385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite Care
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty