NPIMap

Organization Active NPI

A Safe Haven, L.L.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
National Provider Identifier
1770199689
Registry record updated Sep 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
A SAFE HAVEN, L.L.C.
Practice address
1930 S Wabash Ave Ste C1
Chicago, IL 60616-4651
Phone
(312) 372-6707
NPI assigned
Sep 17, 2020
Last updated
Sep 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2020

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

Authorized official

Name
Melanie Dzado
Title
Insurance Biller
Phone
(312) 372-6707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

1930 S Wabash Ave Ste C1
Chicago, IL 60616-4651

Mailing address

15507 Cicero Ave Ste 200
Oak Forest, IL 60452-3633
Phone (312) 372-6707

Other identifiers 1

IdentifierTypeStateIssuer
17002OtherILDHS COMMUNITY MENTAL HEALTH CERTIFICATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
A Safe Haven LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600300800000",
    "number": "1770199689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15507 CICERO AVE STE 200",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604523633",
            "telephone_number": "312-372-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 S WABASH AVE STE C1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606164651",
            "telephone_number": "312-372-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A SAFE HAVEN, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "DZADO",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "INSURANCE BILLER",
        "authorized_official_telephone_number": "312-372-6707"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS COMMUNITY MENTAL HEALTH CERTIFICATION",
            "identifier": "17002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.