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General NPI Number Information
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NPI Number | 1124467345
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Entity Type | Organization
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Legal Business Name | SAFE AND SECURE RESPITE CARE, LLC
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 3091 SKYLINE DR
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City | CRESTVIEW
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State | FL
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Zip | 32539-8176
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Country | US
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Telephone | 850-398-5207
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Fax | 850-398-8735
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Provider Business Mailing Address
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Address Line | 3091 SKYLINE DR
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City | CRESTVIEW
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State | FL
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Zip | 32539-8176
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Country | US
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Telephone | 850-398-5207
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Fax | 850-398-8735
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Authorized Official
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Title or Position | OWNER
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Name | MS. SANDRA ANNE TINGLE
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Credential | MSW, MA
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Telephone | 850-398-5207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9977
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License Number State | FL
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