Healthcare Provider Details

I. General information

NPI: 1437791191
Provider Name (Legal Business Name): A SAFE PLACE NC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 GLENFIELD RD
SNOW HILL NC
28580-8373
US

IV. Provider business mailing address

216 GLENFIELD RD
SNOW HILL NC
28580-8373
US

V. Phone/Fax

Practice location:
  • Phone: 252-521-3809
  • Fax: 252-747-0124
Mailing address:
  • Phone: 252-521-3809
  • Fax: 252-747-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. TOWANDA WILLIAMS BRITT
Title or Position: OWNER
Credential:
Phone: 252-521-3809