1760652853 NPI number — DOUGLAS INVESTMENTS & ASSOCIATES, LLC

Table of content: (NPI 1760652853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760652853 NPI number — DOUGLAS INVESTMENTS & ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS INVESTMENTS & ASSOCIATES, LLC
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:
GRACE OF DOUGLAS
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:
1760652853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 217
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLAS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49406-0217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-857-2141
Provider Business Mailing Address Fax Number:
269-857-1802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 WILEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLAS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49406-5108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-857-2141
Provider Business Practice Location Address Fax Number:
269-857-1802
Provider Enumeration Date:
03/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
423-308-1845

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  034011 , 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)





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