Angels' Safe Haven, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

BH5019 Issued in AZ

Legal business name

ANGELS' SAFE HAVEN, LLC

Practice address

2571 N. 149TH Ave
Goodyear, AZ 85395

Phone

(623) 440-4086

Fax

(623) 440-5939

NPI assigned

Oct 5, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Richard Edward Horne

Title

Ceo

Phone

(623) 210-6382

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1245780964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 7206",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "85374",
            "telephone_number": "623-210-6382",
            "fax_number": "623-440-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2571 N. 149TH AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "85395",
            "telephone_number": "623-440-4086",
            "fax_number": "623-440-5939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8340 N 86th Ln",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853452553",
            "country_code": "US",
            "telephone_number": "602-451-0633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANGELS' SAFE HAVEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "HORNE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "623-210-6382",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "BH5019",
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207699",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Traven Anderson, RPH
• Troy G Anderson, MD
• Hannah Elizabeth Andrews, PA-C
• Mark Anthony Andrews
• Angels in Flight Home Care Inc.
• Angie's LLC (Goodyear home)
• Anthony L. Rubin, Ma, Inc
• Anza Wellness & Recovery Services, PLLC
• Madeline Anzano
• Katrina Carbonell Aquino, PA

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.