Provider Demographics
NPI:1225411796
Name:SAFE REFUGE
Entity Type:Organization
Organization Name:SAFE REFUGE
Other - Org Name:SUBSTANCE ABUSE FOUNDATION OF LONG BEACH, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-987-5722
Mailing Address - Street 1:1041 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3928
Mailing Address - Country:US
Mailing Address - Phone:562-987-5722
Mailing Address - Fax:562-987-4586
Practice Address - Street 1:3139 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4932
Practice Address - Country:US
Practice Address - Phone:562-987-5722
Practice Address - Fax:562-987-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190077CN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1989OtherDRUG MEDI-CAL