Healthcare Provider Details

I. General information

NPI: 1003621210
Provider Name (Legal Business Name): SAFE HARBOR AMORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 05/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7364 LAGOON ROAD,
SPRING HILL FL
34606
US

IV. Provider business mailing address

7364 LAGOON ROAD,
SPRING HILL FL
34606
US

V. Phone/Fax

Practice location:
  • Phone: 909-688-9953
  • Fax:
Mailing address:
  • Phone: 909-688-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KELECHI EMMANUELA IBEH
Title or Position: SAFE HARBOR AMORE, PRINCIPAL
Credential:
Phone: 909-688-9953