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Organization

SAFE HAVEN LLC

Active
Other names
Genesis Health & Wellness Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL G HAGEDORN LMHC, LCAC, SAP, NCC (MANAGING MEMBER)
(812) 499-7950
Entity
Organization

Contact information

Practice address
2029 WASHINGTON AVE, EVANSVILLE, IN 47714-2257
(812) 602-4022
(812) 602-4023
Mailing address
629 INGLE ST, EVANSVILLE, IN 47708-1345
(812) 602-4022
(812) 602-4023

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
1041C0700X
Clinical Social Worker
251S00000X
Community/Behavioral Health Agency
Primary
261Q00000X
Clinic/Center
364S00000X
Clinical Nurse Specialist
364SF0001X
Family Health Clinical Nurse Specialist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300058088
IN
05
300063279
IN
Enumeration date
03/10/2018
Last updated
06/29/2022
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