Healthcare Provider Details

I. General information

NPI: 1437963022
Provider Name (Legal Business Name): PASADENA VILLA MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E PARIS AVE SE STE 150
GRAND RAPIDS MI
49546-6114
US

IV. Provider business mailing address

2525 E PARIS AVE SE STE 150
GRAND RAPIDS MI
49546-6114
US

V. Phone/Fax

Practice location:
  • Phone: 616-207-3818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT SARNACKE
Title or Position: CFO
Credential:
Phone: 615-442-7689