NPIMap

Organization Active NPI

Safe Haven Health Care LLC

Doing business as Safe Haven Hospital of Pocatello

  • Psychiatric Hospital
  • Pocatello, ID
National Provider Identifier
1619208709
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
59 Issued in ID
Legal business name
SAFE HAVEN HEALTH CARE LLC
Doing business as
Safe Haven Hospital of Pocatello
Practice address
1200 Hospital Way
Pocatello, ID 83201-2708
Phone
(208) 233-2570
Fax
(888) 815-8472
NPI assigned
Jan 29, 2010
Last updated
Feb 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Authorized official

Name
Angela Dawn Pasquale
Title
Controller
Phone
(208) 539-0751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 59 ID Primary

Addresses

Primary practice location

1200 Hospital Way
Pocatello, ID 83201-2708

Mailing address

2520 South 5TH Ave
Pocatello, ID 83204
Phone (800) 261-2443

Other identifiers 1

IdentifierTypeStateIssuer
1619208709MedicaidID

Other names 1

  • Safe Haven Hospital of Pocatello Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1619208709. Details of each certification follow.

Hospital certification: CCN 134011

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SAFE HAVEN HOSPITAL OF POCATELLO
Certification status
Terminated Voluntary: merger or closure, Apr 27, 2015
Provider type (POS)
Hospital – Psychiatric
Participating since
Apr 13, 1995
Last certification
Jun 13, 2012
Beds
14
Ownership / control type
Private (not for profit)
Most recent change of ownership
Apr 1, 2010 (1 total)
Facility address
1200 Hospital Way
Pocatello, ID 83201

Hospital certification: CCN 134016

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SAFE HAVEN HOSPITAL OF POCATELLO
Certification status
Terminated Voluntary: other reason for withdrawal, Nov 30, 2017
Provider type (POS)
Hospital – Psychiatric
Participating since
Nov 30, 2016
Last certification
Nov 30, 2016
Beds
14
Ownership / control type
Private (not for profit)
Facility address
1200 Hospital Way
Pocatello, ID 83201

National Provider Directory

National Provider Directory

Locations

1220 Hospital Way
Pocatello, ID 83201
Phone (208) 232-2570

1220 Hospital Way
Pocatello, ID 93201
Phone (208) 327-0504

161 Jefferson Ave
Pocatello, ID 83201
Phone (800) 261-2443

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1264723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1619208709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 SOUTH 5TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83204",
            "telephone_number": "800-261-2443",
            "fax_number": "888-222-6504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012708",
            "telephone_number": "208-233-2570",
            "fax_number": "888-815-8472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HAVEN HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-29",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "PASQUALE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "208-539-0751"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "ID",
            "license": "59",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619208709",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Safe Haven Hospital of Pocatello",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.