Healthcare Provider Details

I. General information

NPI: 1073160370
Provider Name (Legal Business Name): SAFE TRANSITIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 05/17/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 SOVEREIGN CT STE A
BALLWIN MO
63011-4447
US

IV. Provider business mailing address

452 SOVEREIGN CT STE A
BALLWIN MO
63011-4447
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax: 914-470-5056
Mailing address:
  • Phone: 914-376-6100
  • Fax: 914-470-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RADWAN MALAS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 914-376-6100