1457434243 NPI number — HANNAHVILLE INDIAN COMMUNITY

Table of content: (NPI 1457434243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457434243 NPI number — HANNAHVILLE INDIAN COMMUNITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANNAHVILLE INDIAN COMMUNITY
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:
1457434243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N15019 HANNAHVILLE B1 RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-466-2878
Provider Business Mailing Address Fax Number:
906-466-9144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3071 D RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARK RIVER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49807-9716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-466-2878
Provider Business Practice Location Address Fax Number:
906-466-9144
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRETENS
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
BEHAVIORAL HEALTH SUPERVISOR
Authorized Official Telephone Number:
906-466-2878

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  210013 , 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: APRIL 2009 . This is a "COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF)" identifier . This identifiers is of the category "OTHER".




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