Healthcare Provider Details

I. General information

NPI: 1568196186
Provider Name (Legal Business Name): SAFEWAY FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 MAIN STREET LL
BRIDGEPORT CT
06606
US

IV. Provider business mailing address

3101 MAIN STREET LL
BRIDGEPORT CT
06606
US

V. Phone/Fax

Practice location:
  • Phone: 203-727-4629
  • Fax: 203-690-1097
Mailing address:
  • Phone: 203-727-4629
  • Fax: 203-690-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGENE ALLEN
Title or Position: GENERAL PARTNER
Credential:
Phone: 203-521-2874