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General NPI Number Information
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NPI Number | 1932786324
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Entity Type | Organization
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Legal Business Name | SAFER FOUNDATION
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 808 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3929
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Country | US
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Telephone | 773-265-0423
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Fax | 773-887-2456
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Provider Business Mailing Address
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Address Line | 571 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60661-5701
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Country | US
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Telephone | 312-922-2000
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Fax |
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Authorized Official
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Title or Position | AVP, BEHAVIORAL HEALTH
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Name | RUCHA SHASTRI
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Credential | LCPC
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Telephone | 773-831-9131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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