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General NPI Number Information
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NPI Number | 1922886647
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Entity Type | Organization
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Legal Business Name | SAFE HOUSE, LLC
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 9401 HULL STREET RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1422
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Country | US
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Telephone | 804-510-4920
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Fax | 804-362-3962
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Provider Business Mailing Address
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Address Line | 9401 HULL STREET RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1422
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Country | US
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Telephone | 804-510-4920
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Fax | 804-362-3962
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Authorized Official
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Title or Position | CEO
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Name | MR. RONALD JOHNSON
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Credential | MBA, QMHP-A/C, QIDP
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Telephone | 804-510-4920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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