Provider Demographics
NPI:1205607843
Name:SAFARI HEALTH & WELLNESS
Entity type:Organization
Organization Name:SAFARI HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:JUMA
Authorized Official - Last Name:KAP-KIRWOK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-566-3803
Mailing Address - Street 1:2406 WILDWIND RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5503
Mailing Address - Country:US
Mailing Address - Phone:616-566-3803
Mailing Address - Fax:800-831-5105
Practice Address - Street 1:2406 WILDWIND RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-5503
Practice Address - Country:US
Practice Address - Phone:616-566-3803
Practice Address - Fax:800-831-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy