=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609369354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SAFE GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2018
-----------------------------------------------------
Last Update Date | 05/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 841 S CLOVERDALE AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-908-5942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 841 S CLOVERDALE AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-908-5942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OF STAFF
-----------------------------------------------------
Name | GABRIELLA PALMERI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-908-5942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | 0002929657-0001-4
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------