Provider Demographics
NPI:1598206930
Name:SAFE HARBOR WELLNESS LLC
Entity Type:Organization
Organization Name:SAFE HARBOR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SERTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-915-7212
Mailing Address - Street 1:344 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3044
Mailing Address - Country:US
Mailing Address - Phone:614-915-7212
Mailing Address - Fax:
Practice Address - Street 1:304 W KANAWHA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1472
Practice Address - Country:US
Practice Address - Phone:614-656-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1450549305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service