Organization
SAFE SPACE RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER GRAVES (CEO)
(804) 586-4471
Entity
Organization
Contact information
Practice address
4610 STONEBROOK CT, GLEN ALLEN, VA 23060-3632
(804) 586-4471
Mailing address
4100 HYDE PARK DR, CHESTER, VA 23831-4826
(804) 586-4471
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
02/09/2024
Last updated
02/09/2024
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