Organization
SAFE HARBOR RESIDENTIAL SERVICES, INC.
Active
Other names
Safe Harbor Residential - Douty
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GWENDOLYN M. SMITH (ADMINISTRATOR)
(559) 589-6000
Entity
Organization
Contact information
Practice address
2887 N DOUTY ST, HANFORD, CA 93230-1224
(559) 582-7441
(559) 584-8674
Mailing address
PO BOX 163, 318-A E. 4TH STEET, HANFORD, CA 93232-0163
(559) 589-6000
(559) 584-8674
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC60622G
MEDICAL PROVIDER NUMBER
CA
Enumeration date
05/02/2007
Last updated
08/22/2020
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