Healthcare Provider Details

I. General information

NPI: 1073632907
Provider Name (Legal Business Name): TEN SIXTEEN RECOVERY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 E BROOMFIELD ST STE 8
MT PLEASANT MI
48858-4490
US

IV. Provider business mailing address

133 N SAGINAW RD
MIDLAND MI
48640-3350
US

V. Phone/Fax

Practice location:
  • Phone: 989-817-7915
  • Fax:
Mailing address:
  • Phone: 989-631-0241
  • Fax: 989-835-9963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number370048
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number370048
License Number StateMI

VIII. Authorized Official

Name: LINDSAY HARPER DYER
Title or Position: PROGRAM IMPACT MANAGER
Credential: MSSW
Phone: 989-631-0241