Organization
ANGELS' SAFE HAVEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD EDWARD HORNE (CEO)
(623) 210-6382
Entity
Organization
Contact information
Practice address
2571 N. 149TH AVE, GOODYEAR, AZ 85395
(623) 440-4086
(623) 440-5939
Mailing address
P.O. BOX 7206, SURPRISE, AZ 85374
(623) 210-6382
(623) 440-5939
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
BH5019
AZ
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207699
—
AZ
Enumeration date
10/05/2016
Last updated
06/21/2021
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