Provider Demographics
NPI:1912860081
Name:SAFE HARBOR MEDICAL, INC.
Entity type:Organization
Organization Name:SAFE HARBOR MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALICEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-870-8852
Mailing Address - Street 1:2280 E CALVADA BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-3959
Mailing Address - Country:US
Mailing Address - Phone:702-870-8852
Mailing Address - Fax:702-870-8914
Practice Address - Street 1:2280 E CALVADA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-3959
Practice Address - Country:US
Practice Address - Phone:702-870-8852
Practice Address - Fax:702-870-8914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFE HARBOR MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-12-05
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)