Provider Demographics
NPI:1194488932
Name:SAFE HARBOR LLC
Entity Type:Organization
Organization Name:SAFE HARBOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UMAL-KHAYR
Authorized Official - Middle Name:ABDIRAHMAN
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-806-7860
Mailing Address - Street 1:12031 TERRACE CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3384
Mailing Address - Country:US
Mailing Address - Phone:612-806-7860
Mailing Address - Fax:
Practice Address - Street 1:12031 TERRACE CT NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3384
Practice Address - Country:US
Practice Address - Phone:612-806-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service