NPIMap

Organization Active NPI

A Safe Haven, L.L.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
National Provider Identifier
1821872565
Registry record updated Aug 23, 2023
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
3857 W Polk St
Chicago, IL 60624-4018
Phone
(312) 372-6707
NPI assigned
Aug 23, 2023
Last updated
Aug 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Authorized official

Name
Melanie Dzado
Title
Insurance Billing and Verification
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

3857 W Polk St
Chicago, IL 60624-4018

Mailing address

15507 Cicero Ave
Oak Forest, IL 60452-3629
Phone (312) 372-6707

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.

Locations

3857 W Polk St
Chicago, IL 60624

Practitioners & affiliated clinicians

Practitioners 1

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": "1692748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1821872565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15507 CICERO AVE",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604523629",
            "telephone_number": "312-372-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3857 W POLK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606244018",
            "telephone_number": "312-372-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A SAFE HAVEN, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-23",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "DZADO",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "INSURANCE BILLING AND VERIFICATION",
        "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": [],
    "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 Aug 23, 2023; 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.