Organization
NICKELI'S SAFE HAVEN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDYN GARNER LPN (PRESIDENT)
(773) 960-3024
Entity
Organization
Contact information
Practice address
9057 S PARNELL AVE, CHICAGO, IL 60620-2240
(773) 960-3024
Mailing address
9057 S PARNELL AVE, CHICAGO, IL 60620-2240
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
12/06/2018
Last updated
09/20/2021
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