Healthcare Provider Details

I. General information

NPI: 1659643039
Provider Name (Legal Business Name): SPECTRUM HEALTH UNITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S NELSON ST
GREENVILLE MI
48838-2138
US

IV. Provider business mailing address

300 N PATTERSON RD
REED CITY MI
49677-8041
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-6407
  • Fax:
Mailing address:
  • Phone: 231-832-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. JODIE FABER
Title or Position: DIRECTOR HEALTHY LIFESTYLES
Credential:
Phone: 616-754-6407