=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265826044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAFE EMBRACE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2015
-----------------------------------------------------
Last Update Date | 03/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 780 E LINCOLN WAY
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89434-5326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-3466
-----------------------------------------------------
Fax | 775-322-3466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 780 E LINCOLN WAY
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89434-5326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-3466
-----------------------------------------------------
Fax | 775-322-3466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL MANAGER
-----------------------------------------------------
Name | MS. DENISE SUSANNE DIAZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 775-342-8115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------