Healthcare Provider Details

I. General information

NPI: 1679493399
Provider Name (Legal Business Name): SAFE PASSAGE RECOVERY TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MAXWELL ST APT 3
WORCESTER MA
01607-1092
US

IV. Provider business mailing address

18 MAXWELL ST APT 3
WORCESTER MA
01607-1092
US

V. Phone/Fax

Practice location:
  • Phone: 508-769-1307
  • Fax:
Mailing address:
  • Phone: 508-769-1307
  • 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: MARK A DESOURDY
Title or Position: RECOVERY COACH/ PRESIDENT
Credential: CARC
Phone: 508-769-1307