1518116086 NPI number — CATHOLIC SOCIAL SERVICES OF THE UP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518116086 NPI number — CATHOLIC SOCIAL SERVICES OF THE UP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC SOCIAL SERVICES OF THE UP
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:
CATHOLIC CHARITIES OF THE UPPER PENINSULA
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:
1518116086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
347 ROCK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARQUETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49855-4725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-227-9119
Provider Business Mailing Address Fax Number:
906-228-2469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
347 ROCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855-4725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-227-9119
Provider Business Practice Location Address Fax Number:
906-228-2469
Provider Enumeration Date:
09/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAMBO
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
906-227-9116

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7509105340 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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