1245375336 NPI number — SSAC, LLC

Table of content: (NPI 1245375336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245375336 NPI number — SSAC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSAC, 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:
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:
1245375336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26777 CENTRAL PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-4162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-352-7530
Provider Business Mailing Address Fax Number:
248-352-5189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3524 PARK PLAZA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42001-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-442-4579
Provider Business Practice Location Address Fax Number:
800-785-2177
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPARLING
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
248-352-7530

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 54006077 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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