Provider Demographics
NPI:1174048078
Name:A SAFE PLACE COMMUNITY HOUSING, LLC
Entity type:Organization
Organization Name:A SAFE PLACE COMMUNITY HOUSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-780-0432
Mailing Address - Street 1:7203 WALDON PARK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2385
Mailing Address - Country:US
Mailing Address - Phone:704-780-0432
Mailing Address - Fax:
Practice Address - Street 1:2049 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4909
Practice Address - Country:US
Practice Address - Phone:704-780-0432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children