1720672314 NPI number — SAFE HARBOR WELLNESS, INC.

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 1720672314 NPI number — SAFE HARBOR WELLNESS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAFE HARBOR WELLNESS, INC.
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:
SAFE HARBOR WELLNESS & PSYCHIATRIC SERVICES
Provider Other Organization Name Type Code:
3
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:
1720672314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 SCONTICUT NECK RD # 217
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHAVEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02719-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-202-0679
Provider Business Mailing Address Fax Number:
833-499-1787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 COUNTY RD STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTAPOISETT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02739-1585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-202-0679
Provider Business Practice Location Address Fax Number:
866-708-7065
Provider Enumeration Date:
02/24/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BOTELHO
Authorized Official First Name:
ANNE-MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
508-202-0679

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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