Organization
SAFE HAVEN LLC
Active
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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