Provider Demographics
NPI:1760847859
Name:SAFE HARBOR FOR INDIVIDUAL WITH DISABILITIES
Entity Type:Organization
Organization Name:SAFE HARBOR FOR INDIVIDUAL WITH DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER/CARE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-973-4009
Mailing Address - Street 1:2315 NW LITTLE CAT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-4256
Mailing Address - Country:US
Mailing Address - Phone:850-973-4009
Mailing Address - Fax:
Practice Address - Street 1:2315 NW LITTLE CAT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-4256
Practice Address - Country:US
Practice Address - Phone:850-973-4009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009552100Medicaid