Safe Haven LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SAFE HAVEN LLC

Doing business as

Genesis Health & Wellness Center

Practice address

2029 Washington Ave
Evansville, IN 47714-2257

Phone

(812) 602-4022

Fax

(812) 602-4023

NPI assigned

Mar 10, 2018

Last updated

Jun 29, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael G Hagedorn, LMHC, LCAC, SAP, NCCNPI 1346796810

Title

Managing Member

Phone

(812) 499-7950

Specialties & licenses 8

Addresses

Other identifiers 2

Other names 1

• Genesis Health & Wellness Center Doing business as

Locations

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael G Hagedorn, LCAC

  • Addiction (Substance Use Disorder) Counselor
  • Evansville, IN
  • NPI 1346796810
  NPD Authorized official
• Martha F. Hernandez, M.D.

  • Psychiatry Physician
  • Gary, IN
  • NPI 1528284452
  NPD
• Jordan Wayne Milby, LSW

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1750739421
  NPD
• Sara Marie Burns, LCSW

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1821646001
  NPD (past)
• Amy Evans

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1952966046

  Addiction (Substance Use Disorder)

  NPD (past)
• Tiphani Fillingim

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1770096190
  NPD (past)
• Leslie A Hagedorn, LSW

  • Social Worker
  • Evansville, IN
  • NPI 1710429907
  NPD (past)
• Bailey Elizabeth Helfert, LCSW

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1669056008

  Addiction (Substance Use Disorder)

  NPD (past)
• Vivian Lynne Ireton, LCSW, LAC

  • Clinical Social Worker
  • Newburgh, IN
  • NPI 1639433345

  Addiction (Substance Use Disorder)

  NPD (past)
• Leeanne Meriwether, LCSW

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1144812926

  Mental Health

  NPD (past)
• Amy E Miller, LMHCA

  • Mental Health Counselor
  • Evansville, IN
  • NPI 1124510490
  NPD (past)
• Rachael M Virgin, LCSW

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1649897018

  Addiction (Substance Use Disorder)

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1164925772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 INGLE ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477081345",
            "telephone_number": "812-602-4022",
            "fax_number": "812-602-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2029 WASHINGTON AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477142257",
            "telephone_number": "812-602-4022",
            "fax_number": "812-602-4023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "629 Ingle St",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477081345",
            "country_code": "US",
            "telephone_number": "812-602-4022",
            "fax_number": "812-602-4023",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "124 E Powell Ave",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477131671",
            "country_code": "US",
            "telephone_number": "812-602-4022",
            "fax_number": "812-602-4023",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1010 S Weinbach Ave",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477142934",
            "country_code": "US",
            "telephone_number": "812-602-4022",
            "fax_number": "812-602-4023",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "122 S 3rd St",
            "address_purpose": "LOCATION",
            "city": "Rockport",
            "state": "IN",
            "postal_code": "476351302",
            "country_code": "US",
            "telephone_number": "812-602-4022",
            "fax_number": "812-602-4023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAFE HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-10",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "HAGEDORN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "812-499-7950",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMHC, LCAC, SAP, NCC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300063279",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300058088",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Genesis Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Madison C Rynkiewich, MSOT
• David L S Ryon, MD
• Sacred Spark Therapy LLC
• Lois Sadler
• Muhammad Bilal Safdar, MBBS
• Amber Sager-Grindle
• Lyra Sagez
• Jahnavi Sagi, MD
• Beth Sailer, MSW
• Jessica M Sale, NP

• Community/Behavioral Health Agency in Evansville, IN
• Providers in Evansville, IN by specialty
• Community/Behavioral Health Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.