| Safehaus Inc | |
|
26803 Ryan Rd Warren MI 48091-4075 | |
| (586) 477-7472 | |
| (586) 262-1011 |
| Full Name | Safehaus Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 26803 Ryan Rd, Warren, Michigan |
| Authorized Official Name and Position | Roman John Kolodchin (CEO) |
| Authorized Official Contact | 5864777472 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Safehaus Inc 26803 Ryan Rd Warren MI 48091-4075 Ph: (586) 477-7472 | Safehaus Inc 26803 Ryan Rd Warren MI 48091-4075 Ph: (586) 477-7472 |
| NPI Number | 1225755440 |
|---|---|
| Provider Enumeration Date | 10/27/2022 |
| Last Update Date | 01/22/2024 |
| Certification Date | 01/22/2024 |
| Medicare PECOS PAC ID | 6406398601 |
|---|---|
| Medicare Enrollment ID | O20240603003785 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225755440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Robert J Lagrou |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629279351 PECOS PAC ID: 3779645270 Enrollment ID: I20081217000396 |
| Provider Name | Kevin P Bautel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598428856 PECOS PAC ID: 1759771389 Enrollment ID: I20211214000865 |
| Provider Name | Roman John Kolodchin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679900047 PECOS PAC ID: 8820981426 Enrollment ID: I20240612001298 |
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