1508010679 NPI number — SALVATION ARMY HARBOR LIGHT MACOMB

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 1508010679 NPI number — SALVATION ARMY HARBOR LIGHT MACOMB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALVATION ARMY HARBOR LIGHT MACOMB
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:
1508010679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42590 STEPNITZ DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48036-3161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14030 LAKESIDE BLVD N
Provider Second Line Business Practice Location Address:
APT C-221
Provider Business Practice Location Address City Name:
SHELBY TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48315-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-212-7734
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SEAVER
Authorized Official First Name:
MAJOR
Authorized Official Middle Name:
Authorized Official Title or Position:
SITE SUPERVISOR
Authorized Official Telephone Number:
586-954-1838

Provider Taxonomy Codes

  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com