Healthcare Provider Details

I. General information

NPI: 1043121452
Provider Name (Legal Business Name): SAFE PATH LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LAMON ST STE 127
FAYETTEVILLE NC
28301-4917
US

IV. Provider business mailing address

251 OAK FOREST DR
BRICK NJ
08724-0713
US

V. Phone/Fax

Practice location:
  • Phone: 910-600-0299
  • Fax:
Mailing address:
  • Phone: 917-969-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: IZABELA IRENA FRATTAROLI
Title or Position: OWNER
Credential:
Phone: 917-969-3675