Provider Demographics
NPI:1891239380
Name:SAFE HARBORS
Entity Type:Organization
Organization Name:SAFE HARBORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:REICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-577-0128
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:LANSE
Mailing Address - State:PA
Mailing Address - Zip Code:16849-0040
Mailing Address - Country:US
Mailing Address - Phone:814-577-0128
Mailing Address - Fax:
Practice Address - Street 1:2018 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:MORRISDALE
Practice Address - State:PA
Practice Address - Zip Code:16858
Practice Address - Country:US
Practice Address - Phone:814-577-0128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0181391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty