# SAFE HARBOUR LIVING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316246986
- **Authorized official:** MS. TALIS BURRELL (CEO)
- **Authorized official phone:** (770) 474-4472

## Contact information

- **Practice address:** 3784 FREMONT DR, ELLENWOOD, GA 30294-6660
- **Practice address phone:** (770) 474-4472
- **Practice address fax:** (770) 972-1791
- **Mailing address:** 3784 FREMONT DR, ELLENWOOD, GA 30294-6660
- **Mailing address phone:** (770) 474-4472
- **Mailing address fax:** (770) 972-1791

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 031013099 | GA | Yes |
| 320700000X | Physical Disabilities Residential Treatment Facility | 031013099 | GA | — |

## Other

- **Enumeration date:** 03/22/2011
- **Last updated:** 03/22/2011