Healthcare Provider Details

I. General information

NPI: 1619604238
Provider Name (Legal Business Name): SPECTRUM HEALTH UNITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 S SHERIDAN RD
STANTON MI
48888-8906
US

IV. Provider business mailing address

100 MICHIGAN NE ST MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-754-3001
  • Fax:
Mailing address:
  • Phone: 616-486-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RYAN CATIGNANI
Title or Position: VP FINANCE
Credential:
Phone: 947-522-0008