Healthcare Provider Details

I. General information

NPI: 1447744974
Provider Name (Legal Business Name): SAFARI HEALTHCARE ASSOCIATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 WILDWIND RD
LAS CRUCES NM
88007-5503
US

IV. Provider business mailing address

2406 WILDWIND RD
LAS CRUCES NM
88007-5503
US

V. Phone/Fax

Practice location:
  • Phone: 800-831-5105
  • Fax: 800-886-6605
Mailing address:
  • Phone: 800-831-5105
  • Fax: 800-886-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NELSON JUMA KAP-KIRWOK
Title or Position: OFFICER
Credential:
Phone: 616-566-3803