Provider Demographics
NPI:1700010691
Name:SAFEWAY HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:SAFEWAY HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAROH
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:817-899-3146
Mailing Address - Street 1:2321 S BELT LINE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4181
Mailing Address - Country:US
Mailing Address - Phone:972-262-7662
Mailing Address - Fax:972-262-7663
Practice Address - Street 1:2321 S BELT LINE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4181
Practice Address - Country:US
Practice Address - Phone:972-262-7662
Practice Address - Fax:972-262-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012771251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747646Medicare PIN