Healthcare Provider Details

I. General information

NPI: 1366279705
Provider Name (Legal Business Name): SAFARI HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/11/2025
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S MESQUITE ST
LAS CRUCES NM
88001-3622
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: 800-831-5105
Mailing address:
  • Phone: 616-566-3803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

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