Healthcare Provider Details

I. General information

NPI: 1821342866
Provider Name (Legal Business Name): SACRED BEGINNINGS TRANSITIONAL HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 HERMITAGE ST SE
GRAND RAPIDS MI
49506-1420
US

IV. Provider business mailing address

PO BOX 9472
WYOMING MI
49509-0472
US

V. Phone/Fax

Practice location:
  • Phone: 616-272-4312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LESLIE F KING
Title or Position: CHAIRMAN-CEO
Credential:
Phone: 616-819-9840