Provider Demographics
NPI:1689841298
Name:SAFE HARBOUR
Entity Type:Organization
Organization Name:SAFE HARBOUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARISE
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:FRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:BHS/QP
Authorized Official - Phone:910-265-4666
Mailing Address - Street 1:13 EAST DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8214
Mailing Address - Country:US
Mailing Address - Phone:910-265-4666
Mailing Address - Fax:
Practice Address - Street 1:13 EAST DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-8214
Practice Address - Country:US
Practice Address - Phone:910-265-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation