| 616 Sud Services, Llc | |
|
852 47th St Sw Ste 8 Wyoming MI 49509-5104 | |
| (616) 878-3223 | |
| (616) 878-3211 |
| Full Name | 616 Sud Services, Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 852 47th St Sw Ste 8, Wyoming, Michigan |
| Authorized Official Name and Position | Mario I. Ledesma (CLINICAN/OWNER) |
| Authorized Official Contact | 6168783223 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 616 Sud Services, Llc 852 47th St Sw Ste 8 Wyoming MI 49509-5104 Ph: (616) 878-3223 | 616 Sud Services, Llc 852 47th St Sw Ste 8 Wyoming MI 49509-5104 Ph: (616) 878-3223 |
| NPI Number | 1518670710 |
|---|---|
| Provider Enumeration Date | 01/03/2023 |
| Last Update Date | 03/31/2025 |
| Certification Date | 03/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518670710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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