| Sanford Behavioral Health Outpatient Llc | |
|
15146 16th Ave Marne MI 49435-9605 | |
| (844) 776-9651 | |
| Not Available |
| Full Name | Sanford Behavioral Health Outpatient Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 15146 16th Ave, Marne, Michigan |
| Authorized Official Name and Position | Stephanie Robinson (CREDENTIALING & CONTRACTING MANAGER) |
| Authorized Official Contact | 6165209074 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanford Behavioral Health Outpatient Llc 15146 16th Ave Marne MI 49435-9605 Ph: (844) 776-9651 | Sanford Behavioral Health Outpatient Llc 15146 16th Ave Marne MI 49435-9605 Ph: (844) 776-9651 |
| NPI Number | 1679201271 |
|---|---|
| Provider Enumeration Date | 08/11/2022 |
| Last Update Date | 08/29/2022 |
| Certification Date | 08/29/2022 |
| Medicare PECOS PAC ID | 6709243629 |
|---|---|
| Medicare Enrollment ID | O20230608001937 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679201271 | NPI | - | NPPES |
| Provider Name | Gilbert A Masterson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497740930 PECOS PAC ID: 3375635006 Enrollment ID: I20070824000761 |
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