1033553128 NPI number — SOUTH CENTRAL MICHIGAN SUBSTANCE ABUSE COMMISSION MINORITY PROGRAM SER

Table of content: (NPI 1033553128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033553128 NPI number — SOUTH CENTRAL MICHIGAN SUBSTANCE ABUSE COMMISSION MINORITY PROGRAM SER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL MICHIGAN SUBSTANCE ABUSE COMMISSION MINORITY PROGRAM SER
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:
SUBSTANCE ABUSE PREVENTION SERVICES
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:
1033553128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 E MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49224-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-629-2113
Provider Business Mailing Address Fax Number:
517-905-5963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBION
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49224-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-629-2113
Provider Business Practice Location Address Fax Number:
517-905-5963
Provider Enumeration Date:
04/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BONNER
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
517-629-2113

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , 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: 1020SAPS . This is a "SUBSTANCE ABUSE PREVENTION MCBAP CERTIFIED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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