1083607238 NPI number — SAMARITAS LUTHERAN SOCIAL SERVICES OF MICHIGAN

Table of content: (NPI 1083607238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083607238 NPI number — SAMARITAS LUTHERAN SOCIAL SERVICES OF MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMARITAS LUTHERAN SOCIAL SERVICES OF MICHIGAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUTHERAN SOCIAL SERVICES OF MICHIGAN
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083607238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8131 E. JEFFERSON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-823-7700
Provider Business Mailing Address Fax Number:
313-823-9604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3161 DAVENPORT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-799-1902
Provider Business Practice Location Address Fax Number:
989-799-0805
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CEDERSTROM
Authorized Official First Name:
JENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCE OFFICER
Authorized Official Telephone Number:
586-506-0325

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  734110 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 10700000219 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09581 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2150787 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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