Provider Demographics
NPI:1841660834
Name:SAFARI SERVICES LLC
Entity type:Organization
Organization Name:SAFARI SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABUKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-481-7586
Mailing Address - Street 1:10301 UNIVERSITY AVE NE
Mailing Address - Street 2:107
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-8023
Mailing Address - Country:US
Mailing Address - Phone:612-481-7586
Mailing Address - Fax:
Practice Address - Street 1:10301 UNIVERSITY AVE NE STE 107
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-8023
Practice Address - Country:US
Practice Address - Phone:612-481-7586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1081095-1-HCBS305R00000X
171R00000X, 251S00000X, 171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health