Provider Demographics
NPI:1649078460
Name:SAFE SPACE CUMBERLAND INC
Entity type:Organization
Organization Name:SAFE SPACE CUMBERLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-609-8652
Mailing Address - Street 1:1019 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-4638
Mailing Address - Country:US
Mailing Address - Phone:240-609-8652
Mailing Address - Fax:
Practice Address - Street 1:1019 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4638
Practice Address - Country:US
Practice Address - Phone:240-609-8652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management