1427390178 NPI number — FENTON BEHAVIORAL HEALTH SERVICES

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 1427390178 NPI number — FENTON BEHAVIORAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FENTON BEHAVIORAL HEALTH SERVICES
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:
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:
1427390178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1122 N LEROY ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FENTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48430-2789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-629-4224
Provider Business Mailing Address Fax Number:
810-629-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 N LEROY ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FENTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48430-2789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-629-4224
Provider Business Practice Location Address Fax Number:
810-629-4234
Provider Enumeration Date:
03/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LAGUIRE-QUINN
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER/OPERATOR/PRACTITIONER
Authorized Official Telephone Number:
810-629-4224

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  250045 , 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)





Copyright © 2007-2025 www.npivalidator.com