Healthcare Provider Details

I. General information

NPI: 1568391464
Provider Name (Legal Business Name): MYSAFENESTLIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 OAK FOREST DR
BRICK NJ
08724-0713
US

IV. Provider business mailing address

251 OAK FOREST DR
BRICK NJ
08724-0713
US

V. Phone/Fax

Practice location:
  • Phone: 469-567-9994
  • Fax:
Mailing address:
  • Phone: 469-567-9994
  • Fax: 469-567-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: IZABELA I FRATTAROLI
Title or Position: DIRECTOR
Credential: FRATTAROLI
Phone: 469-567-9994