Healthcare Provider Details

I. General information

NPI: 1215773056
Provider Name (Legal Business Name): WAYGFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2576 E BROOKS RD
FREELAND MI
48623-9431
US

IV. Provider business mailing address

331 W FIKE RD
SANFORD MI
48657-9113
US

V. Phone/Fax

Practice location:
  • Phone: 989-430-5795
  • Fax:
Mailing address:
  • Phone: 989-430-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CECIL PATRICK
Title or Position: OWNER
Credential: RECOVERY COACH
Phone: 989-430-5795