MEDICARE: SAFEWAY HEALTHCARE SERVICES INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	012771	TX

General Provider Information

NPI Number	:	1700010691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY HEALTHCARE SERVICES INC.

Provider Business Mailing Address
First Line	:	2100 VIRGINIA ST STE H
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-3798
Country	:	US
Telephone Number	:	972-262-7662
Fax Number	:	972-262-7663

Provider Business Practice Location Address
First Line	:	2100 VIRGINIA ST STE H
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-3798
Country	:	US
Telephone Number	:	972-262-7662
Fax Number	:	972-262-7663

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CLIFFORD AKHAROH
Credential	:	ADMINISTRATOR
Telephone Number	:	817-899-3146

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	03/26/2026

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