1063660199 NPI number — CATHOLIC SOCIAL SERVICES OF THE U.P.

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 1063660199 NPI number — CATHOLIC SOCIAL SERVICES OF THE U.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC SOCIAL SERVICES OF THE U.P.
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:
6
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:
1063660199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 S STEPHENSON AVE
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
IRON MOUNTAIN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49801-3458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-774-3323
Provider Business Mailing Address Fax Number:
906-774-2556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 BRADY AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPIAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-265-5097
Provider Business Practice Location Address Fax Number:
906-265-5155
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ZIOMKOWSKI
Authorized Official First Name:
LAURENCE
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: 7509106980 . 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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