Healthcare Provider Details

I. General information

NPI: 1972860005
Provider Name (Legal Business Name): SAMARITAS LUTHERAN SOCIAL SERVICES OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S COCHRAN AVE
CHARLOTTE MI
48813-1510
US

IV. Provider business mailing address

8131 E JEFFERSON AVE
DETROIT MI
48214-2610
US

V. Phone/Fax

Practice location:
  • Phone: 517-325-9090
  • Fax: 517-325-9091
Mailing address:
  • Phone: 269-345-5776
  • Fax: 269-345-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberCB390258392
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRIDGETTE ZAPPACOSTA
Title or Position: CFO
Credential:
Phone: 313-308-2768