Healthcare Provider Details

I. General information

NPI: 1962162529
Provider Name (Legal Business Name): SAFE HOUSE WELLNESS & HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E BASELINE RD STE 206
TEMPE AZ
85283-1453
US

IV. Provider business mailing address

3116 S MILL AVE STE 115
TEMPE AZ
85282-3657
US

V. Phone/Fax

Practice location:
  • Phone: 202-807-5522
  • Fax:
Mailing address:
  • Phone: 202-807-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KING HARRISON
Title or Position: VP
Credential:
Phone: 202-807-5522