Provider Demographics
NPI:1013622638
Name:SAFE ARK WELLNESS LLC
Entity type:Organization
Organization Name:SAFE ARK WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAMANZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-876-4344
Mailing Address - Street 1:3336 N 32ND ST STE 111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6241
Mailing Address - Country:US
Mailing Address - Phone:480-876-4344
Mailing Address - Fax:
Practice Address - Street 1:3336 N 32ND ST STE 111
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6241
Practice Address - Country:US
Practice Address - Phone:480-876-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health