1467946723 NPI number — THE SANA INITIATIVE, LLC

Table of content: (NPI 1467946723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467946723 NPI number — THE SANA INITIATIVE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SANA INITIATIVE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467946723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13536 KELANNI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49325-9628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-929-0248
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
583 ADA DR SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49301-9160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-929-0248
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ZUVERINK
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-FOUNDER
Authorized Official Telephone Number:
616-929-0248

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401014056 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 6801097875 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 6801100309 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1760938435 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407279250 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1134509193 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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