Provider Demographics
NPI:1699295949
Name:A SAFE PLACE SERVICES, LLC
Entity type:Organization
Organization Name:A SAFE PLACE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-204-8599
Mailing Address - Street 1:6815 W. CAPITOL DRIVE SUITE 117
Mailing Address - Street 2:6815 W. CAPITOL DRIVE SUITE 117
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216
Mailing Address - Country:US
Mailing Address - Phone:414-204-8599
Mailing Address - Fax:414-204-8535
Practice Address - Street 1:6815 W CAPITOL DR STE 117
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2056
Practice Address - Country:US
Practice Address - Phone:414-204-8599
Practice Address - Fax:414-204-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care