Provider Demographics
NPI:1598078735
Name:SAFE FOUNDATION
Entity Type:Organization
Organization Name:SAFE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DWECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-569-7233
Mailing Address - Street 1:PO BOX 230060
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-0060
Mailing Address - Country:US
Mailing Address - Phone:866-569-7233
Mailing Address - Fax:718-336-6815
Practice Address - Street 1:255 AVENUE W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5202
Practice Address - Country:US
Practice Address - Phone:866-569-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004253261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder