1922276070 NPI number — HIAWATHA COMMUNITY MENTAL HEALTH AUTHORITY

Table of content: (NPI 1922276070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922276070 NPI number — HIAWATHA COMMUNITY MENTAL HEALTH AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIAWATHA COMMUNITY MENTAL HEALTH AUTHORITY
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:
HIAWATHA BEHAVIORAL HEALTH
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:
1922276070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 N LAKE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANISTIQUE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49854-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-341-2144
Provider Business Mailing Address Fax Number:
906-341-5793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 N LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANISTIQUE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49854-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-341-2144
Provider Business Practice Location Address Fax Number:
906-341-5793
Provider Enumeration Date:
02/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HARMA
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
906-341-2144

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: 7509104110 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7509104120 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7509104130 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com