Healthcare Provider Details

I. General information

NPI: 1619460326
Provider Name (Legal Business Name): SAFER FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S KEDZIE AVE
CHICAGO IL
60612-3929
US

IV. Provider business mailing address

571 W JACKSON BLVD
CHICAGO IL
60661-5706
US

V. Phone/Fax

Practice location:
  • Phone: 773-320-7160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA05920005A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License NumberA05920005A
License Number StateIL

VIII. Authorized Official

Name: VICTOR DICKSON
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 312-922-4767