Healthcare Provider Details

I. General information

NPI: 1760847859
Provider Name (Legal Business Name): SAFE HARBOR FOR INDIVIDUAL WITH DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 NW LITTLE CAT RD
MADISON FL
32340-4256
US

IV. Provider business mailing address

2315 NW LITTLE CAT RD
MADISON FL
32340-4256
US

V. Phone/Fax

Practice location:
  • Phone: 850-973-4009
  • Fax:
Mailing address:
  • Phone: 850-973-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TERESA YVETTE ALEXANDER
Title or Position: CASE MANAGER/CARE COORDINATOR
Credential:
Phone: 850-973-4009