MEDICARE: SAFE JOURNEY 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912299231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE JOURNEY LLC

Provider Business Mailing Address
First Line	:	8316 SOUTHERN SPRINGS DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8413
Country	:	US
Telephone Number	:	317-692-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	8316 SOUTHERN SPRINGS DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8413
Country	:	US
Telephone Number	:	317-692-9232
Fax Number	:

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	MS. AMELIA A HAGEDORN
Credential	:
Telephone Number	:	317-692-9232

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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