Provider Demographics
NPI:1861079816
Name:SAFE HARBOR HEALTH, LLC
Entity type:Organization
Organization Name:SAFE HARBOR HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BEHAVIORAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLESAREVA
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, LCSW, CSAC
Authorized Official - Phone:608-845-2081
Mailing Address - Street 1:706 KENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1017
Mailing Address - Country:US
Mailing Address - Phone:608-845-2081
Mailing Address - Fax:
Practice Address - Street 1:706 KENWOOD CIR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1017
Practice Address - Country:US
Practice Address - Phone:608-845-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100093506Medicaid