Healthcare Provider Details

I. General information

NPI: 1841660834
Provider Name (Legal Business Name): SAFARI SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 UNIVERSITY AVE NE STE 107
BLAINE MN
55434-8023
US

IV. Provider business mailing address

10301 UNIVERSITY AVE NE 107
BLAINE MN
55434-8023
US

V. Phone/Fax

Practice location:
  • Phone: 612-481-7586
  • Fax:
Mailing address:
  • Phone: 612-481-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number1081095-1-HCBS
License Number StateMN

VIII. Authorized Official

Name: ASHA M ABUKAR
Title or Position: OWNER/MANAGER
Credential:
Phone: 612-481-7586