Provider Demographics
NPI:1750607032
Name:SAFE HARBOR FREE CLINIC
Entity type:Organization
Organization Name:SAFE HARBOR FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:GRIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-870-7384
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-0741
Mailing Address - Country:US
Mailing Address - Phone:425-870-7384
Mailing Address - Fax:
Practice Address - Street 1:9631 269TH ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8071
Practice Address - Country:US
Practice Address - Phone:425-870-7384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable