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General NPI Number Information
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NPI Number | 1598206930
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Entity Type | Organization
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Legal Business Name | SAFE HARBOR WELLNESS LLC
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Dates
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Enumeration Date | 03/18/2017
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 304 W KANAWHA AVE
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City | COLUMBUS
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State | OH
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Zip | 43214-1472
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Country | US
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Telephone | 614-656-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 344 LAKESIDE DR
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City | WESTERVILLE
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State | OH
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Zip | 43081-3044
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Country | US
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Telephone | 614-915-7212
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ELIZABETH SERTELL
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Credential |
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Telephone | 614-915-7212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | I.1450549
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License Number State | OH
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