| Sue E Ryder Llc | |
|
3503 Greenleaf Blvd Ste 102 Kalamazoo MI 49008-2580 | |
| (269) 207-0272 | |
| Not Available |
| Full Name | Sue E Ryder Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3503 Greenleaf Blvd Ste 102, Kalamazoo, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sue E Ryder Llc Po Box 10 Mason MI 48854-0010 Ph: (517) 676-9788 | Sue E Ryder Llc 3503 Greenleaf Blvd Ste 102 Kalamazoo MI 49008-2580 Ph: (269) 207-0272 |
| NPI Number | 1356736821 |
|---|---|
| Provider Enumeration Date | 04/01/2015 |
| Last Update Date | 02/15/2024 |
| Certification Date | 02/15/2024 |
| Medicare PECOS PAC ID | 2062733660 |
|---|---|
| Medicare Enrollment ID | O20150608002875 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356736821 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Sue E Ryder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386747582 PECOS PAC ID: 5890704795 Enrollment ID: I20060420000022 |
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