Healthcare Provider Details

I. General information

NPI: 1487419180
Provider Name (Legal Business Name): SAFE SPACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 S 9TH ST
LOUISVILLE KY
40208-2254
US

IV. Provider business mailing address

1467 S 9TH ST
LOUISVILLE KY
40208-2254
US

V. Phone/Fax

Practice location:
  • Phone: 502-618-0835
  • Fax: 502-665-0500
Mailing address:
  • Phone: 502-618-0835
  • Fax: 502-665-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAMERON BROWN
Title or Position: CEO
Credential:
Phone: 920-252-9024