Healthcare Provider Details

I. General information

NPI: 1184807216
Provider Name (Legal Business Name): HEALTHSOURCE SAGINAW, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 HOSPITAL RD
SAGINAW MI
48603-9622
US

IV. Provider business mailing address

3340 HOSPITAL RD
SAGINAW MI
48603-9622
US

V. Phone/Fax

Practice location:
  • Phone: 989-790-7700
  • Fax: 989-964-5008
Mailing address:
  • Phone: 989-790-7700
  • Fax: 989-964-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY E WILLIAMS
Title or Position: DIR PATIENT ACCOUNTING
Credential:
Phone: 989-790-7783