1457103491 NPI number — SAFE HARBOR THERAPY, P.L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457103491 NPI number — SAFE HARBOR THERAPY, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFE HARBOR THERAPY, P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457103491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 ALSTON BLVD STE C
Provider Second Line Business Mailing Address:
STE C PMB 1003
Provider Business Mailing Address City Name:
HAMPSTEAD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28443-7002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 AZALEA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPSTEAD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28443-8040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-212-6757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2024

Additional Information

Authorized Official

Authorized Official Last Name:
WIEMAN
Authorized Official First Name:
MADELINE
Authorized Official Middle Name:
BROPHY
Authorized Official Title or Position:
OWNER AND THERAPIST
Authorized Official Telephone Number:
910-212-6757

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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