| Safe Space Llc | |
|
1467 S 9th St Louisville KY 40208-2254 | |
| (502) 618-0835 | |
| (502) 665-0500 |
| Full Name | Safe Space Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1467 S 9th St, Louisville, Kentucky |
| Authorized Official Name and Position | Nasira Shaadiyah Mah-jabeen (CREDENTIALING AGENT) |
| Authorized Official Contact | 5025790170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Safe Space Llc 1467 S 9th St Louisville KY 40208-2254 Ph: (502) 618-0835 | Safe Space Llc 1467 S 9th St Louisville KY 40208-2254 Ph: (502) 618-0835 |
| NPI Number | 1487419180 |
|---|---|
| Provider Enumeration Date | 02/21/2024 |
| Last Update Date | 10/07/2024 |
| Certification Date | 10/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487419180 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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