MEDICARE: SAFE RESPONSE, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1760192132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE RESPONSE, LLC

Provider Business Mailing Address
First Line	:	6502 E WESTFIELD BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1292
Country	:	US
Telephone Number	:	260-615-1122
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 WASHINGTON BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3535
Country	:	US
Telephone Number	:	260-615-1122
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	STEPHANIE JOHNSON
Credential	:
Telephone Number	:	260-615-1122

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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Directions to “SAFE RESPONSE, LLC ” Practice Location

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