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General NPI Number Information
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NPI Number | 1962386854
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Entity Type | Individual
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Provider Name | KIMBERLY SANDERS
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 14848 FENKELL ST
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City | DETROIT
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State | MI
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Zip | 48227-2646
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Country | US
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Telephone | 248-421-8668
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Fax |
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Provider Business Mailing Address
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Address Line | 30845 RUNNING STRM APT 22
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1281
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Country | US
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Telephone | 248-421-8668
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Fax | 313-397-7708
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | AS820418004
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AS820418004
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | AS820418004
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | AS820418004
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License Number State | MI
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