Provider Demographics
NPI:1467946723
Name:THE SANA INITIATIVE, LLC
Entity Type:Organization
Organization Name:THE SANA INITIATIVE, LLC
Other - Org Name:LIFEOLOGIE INSTITUTE GRAND RAPIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUVERINK
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:616-929-0248
Mailing Address - Street 1:13536 KELANNI DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49325-9628
Mailing Address - Country:US
Mailing Address - Phone:616-929-0248
Mailing Address - Fax:
Practice Address - Street 1:583 ADA DR SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9160
Practice Address - Country:US
Practice Address - Phone:616-929-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014056101YP2500X
MI6801097875104100000X
MI6801100309104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1760938435Medicaid
MI1407279250Medicaid
MI1134509193Medicaid