Provider Demographics
NPI:1740857317
Name:SPIRITUAL FITNESS LLC
Entity type:Organization
Organization Name:SPIRITUAL FITNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIPADA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:313-479-4605
Mailing Address - Street 1:206 S MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2114
Mailing Address - Country:US
Mailing Address - Phone:313-479-4605
Mailing Address - Fax:
Practice Address - Street 1:206 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2114
Practice Address - Country:US
Practice Address - Phone:313-479-4605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty