Provider Demographics
NPI:1699518795
Name:SAFE WITH SELF BHTC
Entity type:Organization
Organization Name:SAFE WITH SELF BHTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIN
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKAIRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-780-4181
Mailing Address - Street 1:329 LETA AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2727
Mailing Address - Country:US
Mailing Address - Phone:810-335-4366
Mailing Address - Fax:
Practice Address - Street 1:2109 MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1027
Practice Address - Country:US
Practice Address - Phone:810-335-4366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty