A Safe Haven, L.L.C.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Chicago, IL
NPI 1114533924 · NPPES record last updated Sep 17, 2020
Key facts
- NPI
- 1114533924
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- A SAFE HAVEN, L.L.C.
- Practice address
- 600 S Wabash Ave
Chicago, IL 60605-1808 - Phone
- (312) 372-6707
- NPI assigned
- Sep 17, 2020
- Organization subpart
- No
Authorized official
- Name
- Melanie Dzado
- Title
- Insurance Biller
- Phone
- (312) 372-6707
Other NPIs on the same Medicare enrollment 7
Corporate family (same tax ID) 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180705001836 | IL | Part B Supplier - Clinic/Group Practice | 9931455946 |
Receives reassigned benefits from 1 practitioner 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chicago, IL |
National Provider Directory
- Tax ID family
- A Safe Haven LLC
Locations
600 S Wabash Ave
Chicago, IL 60605
Phone (312) 698-4602
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
600 S Wabash Ave
Chicago, IL 60605-1808
Mailing address
15507 Cicero Ave Ste 200
Oak Forest, IL 60452-3633
Phone (312) 372-6707
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17002 | Other | IL | DHS COMMUNITY MENTAL HEALTH CENTER CERTIFICATION |
Other providers in Chicago, IL
- A Plus Plus Therapy, Inc
- A Plus Plus Therapy, LLC.
- A R Imaging, S.C.
- A Rezvan MD SC and Associates
- A Safe Haven, L.L.C.
- A Safe Haven, L.L.C.
- A Safe Haven, L.L.C.
- A Safe Haven, L.L.C.
- A Safe Haven, L.L.C.
- A Safe Haven, L.L.C.
All providers in Chicago, IL · Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.