MEDICARE: SAFE LITE CARE INCORPORATED

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1184182925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE LITE CARE INCORPORATED

Provider Business Mailing Address
First Line	:	5415 CARTA VALLEY LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-6086
Country	:	US
Telephone Number	:	832-407-1189
Fax Number	:

Provider Business Practice Location Address
First Line	:	5415 CARTA VALLEY LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-6086
Country	:	US
Telephone Number	:	832-407-1189
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ENO EKPO
Credential	:
Telephone Number	:	832-407-1189

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	03/12/2019

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Directions to “SAFE LITE CARE INCORPORATED ” Practice Location

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