Healthcare Provider Details

I. General information

NPI: 1558227868
Provider Name (Legal Business Name): A SAFE HAVEN WELLNESS & PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 LOVE FIELD CT
WILLOW SPRING NC
27592-8664
US

IV. Provider business mailing address

100 HICKORY TREE LN
ANGIER NC
27501-7716
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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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