Safe Harbour Living, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

031013099 Issued in GA

Legal business name

SAFE HARBOUR LIVING, LLC

Practice address

3784 Fremont Dr
Ellenwood, GA 30294-6660

Phone

(770) 474-4472

Fax

(770) 972-1791

NPI assigned

Mar 22, 2011

Last updated

Mar 22, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Talis Burrell

Title

Ceo

Phone

(770) 474-4472

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300752000000",
    "number": "1316246986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3784 FREMONT DR",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302946660",
            "telephone_number": "770-474-4472",
            "fax_number": "770-972-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3784 FREMONT DR",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302946660",
            "telephone_number": "770-474-4472",
            "fax_number": "770-972-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HARBOUR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-22",
        "last_updated": "2011-03-22",
        "status": "A",
        "authorized_official_last_name": "BURRELL",
        "authorized_official_first_name": "TALIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-474-4472",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "031013099",
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "GA",
            "license": "031013099",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Ellenwood, GA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; 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.