Provider Demographics
NPI:1134791106
Name:A SAFE PLACE
Entity type:Organization
Organization Name:A SAFE PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-593-3831
Mailing Address - Street 1:4229 BARDSTOWN RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3241
Mailing Address - Country:US
Mailing Address - Phone:502-630-2018
Mailing Address - Fax:
Practice Address - Street 1:4229 BARDSTOWN RD STE 214
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3241
Practice Address - Country:US
Practice Address - Phone:502-630-2018
Practice Address - Fax:502-630-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100576900Medicaid