Provider Demographics
NPI:1528812930
Name:KATRINA RENEES SAFE PLACE LLC
Entity type:Organization
Organization Name:KATRINA RENEES SAFE PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCAS
Authorized Official - Phone:704-352-8043
Mailing Address - Street 1:1213 W MOREHEAD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5576
Mailing Address - Country:US
Mailing Address - Phone:704-325-8336
Mailing Address - Fax:704-325-8356
Practice Address - Street 1:5017 ELIZABETH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4534
Practice Address - Country:US
Practice Address - Phone:704-352-8043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities