NPIMap

Organization Active NPI

Safe Harbor Medical, Inc.

  • Federally Qualified Health Center (FQHC)
  • Las Vegas, NV
National Provider Identifier
1205636032
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAFE HARBOR MEDICAL, INC.
Doing business as
SAFE HARBOR MEDICAL-TRAC B
Practice address
6114 W Charleston Blvd
Las Vegas, NV 89146-1127
Phone
(702) 870-8852
Fax
(702) 870-8914
NPI assigned
Mar 19, 2025
Organization subpart
Yes
Parent organization
SAFE HARBOR MEDICAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tina A Alicea
Title
Ceo
Phone
(702) 870-8852

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

6114 W Charleston Blvd
Las Vegas, NV 89146-1127

Mailing address

2901 N Tenaya Way Ste 100
Las Vegas, NV 89128-1404
Phone (702) 870-8852

Other names 1

  • SAFE HARBOR MEDICAL-TRAC B Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Safe Harbor Medical Inc6 organizations share this tax ID, including this one
Part of
Safe Harbor Medical Inc

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6114 W Charleston Blvd
Las Vegas, NV 89146
Phone (702) 840-6693

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1205636032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N TENAYA WAY STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281404",
            "telephone_number": "702-870-8852",
            "fax_number": "702-870-8914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6114 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461127",
            "telephone_number": "702-870-8852",
            "fax_number": "702-870-8914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HARBOR MEDICAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAFE HARBOR MEDICAL, INC.",
        "enumeration_date": "2025-03-19",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A",
        "authorized_official_last_name": "ALICEA",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-870-8852"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAFE HARBOR MEDICAL-TRAC B",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.