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General NPI Number Information
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NPI Number | 1386589059
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Entity Type | Organization
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Legal Business Name | SAFE REFUGE LLC
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 669 LOOKOUT ST
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City | PONTIAC
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State | MI
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Zip | 48342-2947
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Country | US
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Telephone | 248-251-2555
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Fax | 888-830-8396
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Provider Business Mailing Address
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Address Line | PO BOX 175
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48303-0175
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Country | US
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Telephone | 248-251-2557
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Fax | 888-830-8396
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MR. MICHAEL MACK
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Credential |
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Telephone | 248-251-2557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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