Provider Demographics
NPI:1073877726
Name:A SAFE PLACE
Entity Type:Organization
Organization Name:A SAFE PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-563-5906
Mailing Address - Street 1:7460 GREENWOOD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2260
Mailing Address - Country:US
Mailing Address - Phone:801-793-8774
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST STE 30
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5129
Practice Address - Country:US
Practice Address - Phone:801-793-8774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty