MEDICARE: KIMBERLY SANDERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	AS820418004	MI
2	3104A0625X	Assisted Living Facility (Mental Illness)	AS820418004	MI
3	315P00000X	Intellectual Disabilities Intermediate Care Facility	AS820418004	MI
4	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	AS820418004	MI

General Provider Information

NPI Number	:	1962386854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SANDERS

Provider Business Mailing Address
First Line	:	30845 RUNNING STRM APT 22
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-1281
Country	:	US
Telephone Number	:	248-421-8668
Fax Number	:	313-397-7708

Provider Business Practice Location Address
First Line	:	14848 FENKELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-2646
Country	:	US
Telephone Number	:	248-421-8668
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	09/19/2025

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Directions to “ KIMBERLY SANDERS ” Practice Location

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