Provider Demographics
NPI:1386421428
Name:SAFE AT HOME SERVICE FACILITATION LLC
Entity type:Organization
Organization Name:SAFE AT HOME SERVICE FACILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:571-316-8039
Mailing Address - Street 1:1467 CHESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-3131
Mailing Address - Country:US
Mailing Address - Phone:571-316-8039
Mailing Address - Fax:540-369-3538
Practice Address - Street 1:1467 CHESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-3131
Practice Address - Country:US
Practice Address - Phone:571-316-8039
Practice Address - Fax:540-369-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-0005123OtherCOMMON WEALTH VIRGINIA DEPARTMENT OF HEALTH
VA30017679990001Medicaid