Healthcare Provider Details

I. General information

NPI: 1053149476
Provider Name (Legal Business Name): A SAFE HAVEN WELLNESS & PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 LOVE FIELD CT
WILLOW SPRING NC
27592-8664
US

IV. Provider business mailing address

8813 LOVE FIELD CT
WILLOW SPRING NC
27592-8664
US

V. Phone/Fax

Practice location:
  • Phone: 919-400-7863
  • Fax: 919-290-4754
Mailing address:
  • Phone: 919-400-7863
  • Fax: 919-290-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TREVOR AARON ULRICH
Title or Position: OWNER
Credential: LCP
Phone: 919-400-7863