Provider Demographics
NPI:1053453373
Name:S P G B SERVICES
Entity Type:Organization
Organization Name:S P G B SERVICES
Other - Org Name:SPGB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTCEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CACII
Authorized Official - Phone:269-964-3830
Mailing Address - Street 1:32 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3046
Mailing Address - Country:US
Mailing Address - Phone:517-629-9210
Mailing Address - Fax:517-629-9880
Practice Address - Street 1:101 N ALBION ST
Practice Address - Street 2:HUMAN SERVICES BUILDING
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1500
Practice Address - Country:US
Practice Address - Phone:517-629-9210
Practice Address - Fax:517-629-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI130088101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1705289Medicaid
MI1705289Medicaid