Healthcare Provider Details

I. General information

NPI: 1245321223
Provider Name (Legal Business Name): SENIOR SAFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25594 CORTEZ ST
HARRISON TOWNSHIP MI
48045-2028
US

IV. Provider business mailing address

25594 CORTEZ ST
HARRISON TOWNSHIP MI
48045-2028
US

V. Phone/Fax

Practice location:
  • Phone: 586-321-3029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801082238
License Number StateMI

VIII. Authorized Official

Name: MS. TARA FORTON
Title or Position: OWNER
Credential: LMSW
Phone: 586-321-3029