1144308347 NPI number — S P G B SERVICES

Table of content: (NPI 1144308347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144308347 NPI number — S P G B SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S P G B SERVICES
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:
SPGB SERVICES
Provider Other Organization Name Type Code:
5
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:
1144308347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 W VAN BUREN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49017-3046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-964-3830
Provider Business Mailing Address Fax Number:
269-964-3833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 E PATERSON ST
Provider Second Line Business Practice Location Address:
SAFEHOUSE
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49007-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-342-7348
Provider Business Practice Location Address Fax Number:
269-342-4699
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BONDS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
269-342-7348

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  390139 , 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: 1705289 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com