Provider Demographics
NPI:1003369455
Name:SAFER HOUSE
Entity Type:Organization
Organization Name:SAFER HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED VOCATIONAL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:UPTON
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:903-288-5148
Mailing Address - Street 1:115 S MURCHISON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2662
Mailing Address - Country:US
Mailing Address - Phone:903-292-5108
Mailing Address - Fax:
Practice Address - Street 1:115 S MURCHISON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2662
Practice Address - Country:US
Practice Address - Phone:903-292-5108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320590787218323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility