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General NPI Number Information
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NPI Number | 1144308347
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Entity Type | Organization
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Legal Business Name | S P G B SERVICES
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 118 E PATERSON ST SAFEHOUSE
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City | KALAMAZOO
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State | MI
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Zip | 49007-2531
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Country | US
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Telephone | 269-342-7348
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Fax | 269-342-4699
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Provider Business Mailing Address
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Address Line | 32 W VAN BUREN ST
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3046
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Country | US
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Telephone | 269-964-3830
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Fax | 269-964-3833
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ROBERT E. BONDS JR.
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Credential | LBSW, CAC-11
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Telephone | 269-342-7348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 390139
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License Number State | MI
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