1144421314 NPI number — MICHIGAN BEHAVIORAL HEALTH INSTITUTE 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 1144421314 NPI number — MICHIGAN BEHAVIORAL HEALTH INSTITUTE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN BEHAVIORAL HEALTH INSTITUTE 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:
MBHI
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:
1144421314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
863 N PINE RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ESSEXVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48732-2159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-893-2121
Provider Business Mailing Address Fax Number:
989-893-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
863 N PINE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ESSEXVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48732-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-893-2121
Provider Business Practice Location Address Fax Number:
989-893-2177
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
LEROY
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
989-893-2121

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  090066 , 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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