Healthcare Provider Details

I. General information

NPI: 1205607843
Provider Name (Legal Business Name): SAFARI HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
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: 616-566-3803
  • Fax: 800-831-5105
Mailing address:
  • Phone: 616-566-3803
  • Fax: 800-831-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NELSON JUMA KAP-KIRWOK
Title or Position: OWNER
Credential: RN
Phone: 616-566-3803