MEDICARE: SAFE HARBOR, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023215183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HARBOR, INC.

Provider Business Mailing Address
First Line	:	2982 PETUNIA LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-5090
Country	:	US
Telephone Number	:	505-312-9352
Fax Number	:

Provider Business Practice Location Address
First Line	:	2982 PETUNIA LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-5090
Country	:	US
Telephone Number	:	505-312-9352
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. CHRISTINE OLIVIA CHAPMAN
Credential	:
Telephone Number	:	505-312-9352

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	06/04/2008

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Directions to “SAFE HARBOR, INC. ” Practice Location

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