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General NPI Number Information
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NPI Number | 1487419180
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Entity Type | Organization
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Legal Business Name | SAFE SPACE LLC
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Dates
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Enumeration Date | 02/21/2024
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 1467 S 9TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40208-2254
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Country | US
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Telephone | 502-618-0835
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Fax | 502-665-0500
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Provider Business Mailing Address
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Address Line | 1467 S 9TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40208-2254
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Country | US
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Telephone | 502-618-0835
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Fax | 502-665-0500
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Authorized Official
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Title or Position | CEO
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Name | CAMERON BROWN
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Credential |
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Telephone | 920-252-9024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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