1336466440 NPI number — IRON COUNTY SAMARITAN SERVICES, INC.

Table of content: (NPI 1336466440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336466440 NPI number — IRON COUNTY SAMARITAN SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRON COUNTY SAMARITAN SERVICES, 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:
1336466440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 W GENESEE ST
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
IRON RIVER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49935-1497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-265-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 W GENESEE ST
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
IRON RIVER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49935-1497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-265-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VAN DOREN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
DORRINGTON
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
906-265-2000

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2574-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: L112776 , 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: COUN10-99131 . This is a "COUNSELING SERVICES CONTRACT (CM-F910)" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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