Provider Demographics
NPI:1073974598
Name:SAFE PASSAGE RECOERVY LLC
Entity Type:Organization
Organization Name:SAFE PASSAGE RECOERVY LLC
Other - Org Name:SAFE PASSAGE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-686-6215
Mailing Address - Street 1:1005 NORTHGATE DR # 174
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2500
Mailing Address - Country:US
Mailing Address - Phone:415-578-2069
Mailing Address - Fax:
Practice Address - Street 1:880 LAS GALLINAS AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3437
Practice Address - Country:US
Practice Address - Phone:415-578-2069
Practice Address - Fax:415-578-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder