Provider Demographics
NPI:1932786324
Name:SAFER FOUNDATION
Entity Type:Organization
Organization Name:SAFER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP, BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:RUCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASTRI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-831-9131
Mailing Address - Street 1:571 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5701
Mailing Address - Country:US
Mailing Address - Phone:312-922-2000
Mailing Address - Fax:
Practice Address - Street 1:808 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3929
Practice Address - Country:US
Practice Address - Phone:773-265-0423
Practice Address - Fax:773-887-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)