Provider Demographics
NPI:1952010233
Name:SAFE SPACE - OTP
Entity Type:Organization
Organization Name:SAFE SPACE - OTP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-488-4808
Mailing Address - Street 1:7811 WISE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3339
Mailing Address - Country:US
Mailing Address - Phone:443-488-4808
Mailing Address - Fax:
Practice Address - Street 1:7811 WISE AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-3339
Practice Address - Country:US
Practice Address - Phone:443-376-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFE SPACE HEALTH & WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-16
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder