Healthcare Provider Details

I. General information

NPI: 1124595764
Provider Name (Legal Business Name): SAFE RESIDENTIAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

36 PATRICK DR
WESTBROOK ME
04092-4807
US

IV. Provider business mailing address

36 PATRICK DR
WESTBROOK ME
04092-4807
US

V. Phone/Fax

Practice location:
  • Phone: 207-712-0008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KAREN COLLINS
Title or Position: MANAGER
Credential:
Phone: 207-712-0008