1114039856 NPI number — CENTER FOR EFFECTIVE LIVING INC

Table of content: (NPI 1114039856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114039856 NPI number — CENTER FOR EFFECTIVE LIVING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR EFFECTIVE LIVING INC
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:
LINDA ROSE CLOR CSW PC
Provider Other Organization Name Type Code:
3
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:
1114039856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42657 GARFIELD RD
Provider Second Line Business Mailing Address:
STE 213
Provider Business Mailing Address City Name:
CLINTON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-228-8838
Provider Business Mailing Address Fax Number:
586-228-0813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42657 GARFIELD RD
Provider Second Line Business Practice Location Address:
STE 213
Provider Business Practice Location Address City Name:
CLINTON TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-228-8838
Provider Business Practice Location Address Fax Number:
586-228-0813
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLOR
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
586-228-8838

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6801035885 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 4101005701 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8008981730 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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