1023275328 NPI number — EASTERSEALS MORC HEALTH CARE, INC.

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 1023275328 NPI number — EASTERSEALS MORC HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERSEALS MORC HEALTH CARE, INC.
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:
1023275328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2399 E WALTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48326-1955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-475-6400
Provider Business Mailing Address Fax Number:
248-475-6402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1420 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48504-6208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-238-0475
Provider Business Practice Location Address Fax Number:
810-238-9270
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WIRTH
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
248-475-6400

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)





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