Provider Demographics
NPI:1497070007
Name:SAFER GROUND COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:SAFER GROUND COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-688-3806
Mailing Address - Street 1:315 W SOLOMON ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-3038
Mailing Address - Country:US
Mailing Address - Phone:678-688-3806
Mailing Address - Fax:770-233-2810
Practice Address - Street 1:315 W SOLOMON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-3038
Practice Address - Country:US
Practice Address - Phone:678-688-3806
Practice Address - Fax:770-233-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health