Provider Demographics
NPI:1437012820
Name:A SAFE HAVEN WELLNESS & PRIMARY CARE, LLC
Entity type:Organization
Organization Name:A SAFE HAVEN WELLNESS & PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-400-7863
Mailing Address - Street 1:8813 LOVE FIELD CT
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-8664
Mailing Address - Country:US
Mailing Address - Phone:919-400-7863
Mailing Address - Fax:919-290-4754
Practice Address - Street 1:8813 LOVE FIELD CT
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-8664
Practice Address - Country:US
Practice Address - Phone:919-400-7863
Practice Address - Fax:919-290-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-03
Last Update Date:2025-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center