Provider Demographics
NPI:1356897797
Name:SAFE HAVEN RESIDENTIAL HOMES
Entity type:Organization
Organization Name:SAFE HAVEN RESIDENTIAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:210-563-0768
Mailing Address - Street 1:1226 W GRAND PKWY S
Mailing Address - Street 2:1229
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8442
Mailing Address - Country:US
Mailing Address - Phone:210-563-0768
Mailing Address - Fax:
Practice Address - Street 1:1226 W GRAND PKWY S
Practice Address - Street 2:1229
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8442
Practice Address - Country:US
Practice Address - Phone:210-563-0768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320600000X, 320700000X, 322D00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children