Provider Demographics
NPI:1467197921
Name:SAFEGUARD RELIEF & CARE MEDICAL CENTER
Entity Type:Organization
Organization Name:SAFEGUARD RELIEF & CARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSSENER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-818-4151
Mailing Address - Street 1:6887 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2154
Mailing Address - Country:US
Mailing Address - Phone:561-818-4151
Mailing Address - Fax:
Practice Address - Street 1:6887 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2154
Practice Address - Country:US
Practice Address - Phone:561-818-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEGUARD RELIEF & CARE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021563100Medicaid