Provider Demographics
NPI:1437771870
Name:SAFE HARBOR RECOVERY, LLC
Entity Type:Organization
Organization Name:SAFE HARBOR RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-720-8690
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44482-1212
Mailing Address - Country:US
Mailing Address - Phone:330-469-6822
Mailing Address - Fax:
Practice Address - Street 1:1212 TOD PL NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2475
Practice Address - Country:US
Practice Address - Phone:330-469-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility