Provider Demographics
NPI:1588292601
Name:SAMARITAS
Entity type:Organization
Organization Name:SAMARITAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, SST
Authorized Official - Phone:313-410-7438
Mailing Address - Street 1:923 S BEECHTREE ST STE 10
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2306
Mailing Address - Country:US
Mailing Address - Phone:616-516-9985
Mailing Address - Fax:
Practice Address - Street 1:923 S BEECHTREE ST STE 10
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2306
Practice Address - Country:US
Practice Address - Phone:616-516-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty