Provider Demographics
NPI:1508238783
Name:SAFE SURROUNDINGS NE, LLC
Entity Type:Organization
Organization Name:SAFE SURROUNDINGS NE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNALD
Authorized Official - Suffix:
Authorized Official - Credentials:MLADC, LICSW
Authorized Official - Phone:603-569-5818
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-1464
Mailing Address - Country:US
Mailing Address - Phone:603-569-5818
Mailing Address - Fax:
Practice Address - Street 1:35 CENTER ST
Practice Address - Street 2:SUITE 19
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4324
Practice Address - Country:US
Practice Address - Phone:603-569-5818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0816101YA0400X
NH15291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty