MEDICARE: SAFARI HEALTH & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QP2300X	Primary Care Clinic/Center
2	332800000X	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
3	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1205607843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFARI HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	2406 WILDWIND RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-5503
Country	:	US
Telephone Number	:	616-566-3803
Fax Number	:	800-831-5105

Provider Business Practice Location Address
First Line	:	2406 WILDWIND RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-5503
Country	:	US
Telephone Number	:	616-566-3803
Fax Number	:	800-831-5105

Authorized Official
Title or Position	:	OWNER
Name	:	NELSON JUMA KAP-KIRWOK
Credential	:	RN
Telephone Number	:	616-566-3803

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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Directions to “SAFARI HEALTH & WELLNESS ” Practice Location

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