1699861609 NPI number — FAMILY SERVICE AND CHILDRENS AID

Table of content: (NPI 1699861609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699861609 NPI number — FAMILY SERVICE AND CHILDRENS AID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE AND CHILDRENS AID
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:
Provider Other Organization Name Type Code:
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:
1699861609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 W MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49201-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-787-7920
Provider Business Mailing Address Fax Number:
517-787-2440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 W MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-787-7920
Provider Business Practice Location Address Fax Number:
517-787-2440
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PROCTOR
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
517-787-7920

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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: 138213 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 398186150 . This is a "TRICARE DR S ONLY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0056 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: FAMIL-6361 . This is a "COMPCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 138213 . This is a "PREFFERED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 260078000 . This is a "MAGELLAN EAP CAROL ONLY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: FC-ADR-BF-122763 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1105443 . This is a "CONNECTICUT GENERAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M#38002 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 750910682 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P50798 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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