MEDICARE: SAFESPACE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	324500000X	Substance Abuse Rehabilitation Facility
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1700619533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFESPACE LLC

Provider Business Mailing Address
First Line	:	12655 SW CENTER ST STE 145
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-1864
Country	:	US
Telephone Number	:	971-762-2089
Fax Number	:	971-762-2087

Provider Business Practice Location Address
First Line	:	12655 SW CENTER ST STE 145
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97005-1864
Country	:	US
Telephone Number	:	619-510-3230
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	YARED DARCHA
Credential	:
Telephone Number	:	971-762-2087

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	10/14/2025

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Directions to “SAFESPACE LLC ” Practice Location

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