1508386814 NPI number — RAMON A SANTOS SOCIAL WORKER

Table of content: RAMON A SANTOS SOCIAL WORKER (NPI 1508386814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508386814 NPI number — RAMON A SANTOS SOCIAL WORKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS
Provider First Name:
RAMON
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SOCIAL WORKER
Provider Gender Code:
M

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:
1508386814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776974
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-672-2119
Provider Business Mailing Address Fax Number:
313-432-7759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 CESAR E CHAVEZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-4920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-685-8400
Provider Business Practice Location Address Fax Number:
616-685-1322
Provider Enumeration Date:
06/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  100115 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 6851113986 , 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: 1508386814 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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