Provider Demographics
NPI:1215773056
Name:WAYGFT
Entity type:Organization
Organization Name:WAYGFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RECOVERY COACH
Authorized Official - Phone:989-430-5795
Mailing Address - Street 1:331 W FIKE RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9113
Mailing Address - Country:US
Mailing Address - Phone:989-430-5795
Mailing Address - Fax:
Practice Address - Street 1:2576 E BROOKS RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-9431
Practice Address - Country:US
Practice Address - Phone:989-430-5795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit