Provider Demographics
NPI:1235318734
Name:A SAFE PLACE, LLC
Entity type:Organization
Organization Name:A SAFE PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-538-0032
Mailing Address - Street 1:11 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WELDON
Mailing Address - State:NC
Mailing Address - Zip Code:27890-1516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WELDON
Practice Address - State:NC
Practice Address - Zip Code:27890-1516
Practice Address - Country:US
Practice Address - Phone:252-538-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health