Healthcare Provider Details

I. General information

NPI: 1508770371
Provider Name (Legal Business Name): SAMUEL R STORIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14055 S MASON DR
GRANT MI
49327-9645
US

IV. Provider business mailing address

1159 JOOSTEN ST SW APT 2
WYOMING MI
49509-1424
US

V. Phone/Fax

Practice location:
  • Phone: 231-834-8433
  • Fax:
Mailing address:
  • Phone: 231-282-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: