Healthcare Provider Details

I. General information

NPI: 1235982687
Provider Name (Legal Business Name): SAFE PLACE TREATMENT SERVICES, CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 N BABCOCK ST STE A
MELBOURNE FL
32935-7334
US

IV. Provider business mailing address

2123 HENRY ST NE
PALM BAY FL
32905-2623
US

V. Phone/Fax

Practice location:
  • Phone: 321-208-6186
  • Fax:
Mailing address:
  • Phone: 321-208-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JOHN CURRY
Title or Position: CEO/CAP
Credential: MA, BSHS, CAP, SN
Phone: 321-600-4559