Healthcare Provider Details

I. General information

NPI: 1588292601
Provider Name (Legal Business Name): SAMARITAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 S BEECHTREE ST STE 10
GRAND HAVEN MI
49417-2306
US

IV. Provider business mailing address

923 S BEECHTREE ST STE 10
GRAND HAVEN MI
49417-2306
US

V. Phone/Fax

Practice location:
  • Phone: 616-516-9985
  • Fax:
Mailing address:
  • Phone: 616-516-9985
  • Fax:

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 Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL A PERRY
Title or Position: VP OF QUALITY
Credential: MA, SST
Phone: 313-410-7438