Provider Demographics
NPI:1518670710
Name:616 SUD SERVICES, LLC
Entity Type:Organization
Organization Name:616 SUD SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCJP CADC, SAP
Authorized Official - Phone:616-878-3223
Mailing Address - Street 1:2424 BURTON ST SE STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4833
Mailing Address - Country:US
Mailing Address - Phone:616-878-3223
Mailing Address - Fax:616-878-3211
Practice Address - Street 1:2424 BURTON ST SE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4833
Practice Address - Country:US
Practice Address - Phone:616-878-3223
Practice Address - Fax:616-878-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty