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General NPI Number Information
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NPI Number | 1134911365
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Entity Type | Organization
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Legal Business Name | SANFORD PSYCH SERVICES LLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 221 JOHN ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3237
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Country | US
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Telephone | 844-776-9651
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Fax |
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Provider Business Mailing Address
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Address Line | 15146 16TH AVE
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City | MARNE
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State | MI
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Zip | 49435-9605
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Country | US
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Telephone | 844-776-9651
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MALISSA WEBBER
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Credential |
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Telephone | 616-520-9074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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