| NPI | 1518670710 |
|---|---|
| Former Legal Business Name | 616 SUD SERVICES, LLC |
| Entity Type | Organization |
| Authorized Contact | MARIO I. LEDESMA Clinican/Owner 616-878-3223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2023-01-03 |