1528192853 NPI number — CATHOLIC SOCIAL SERVICES OF LENAWEE COUNTY

Table of content: (NPI 1528192853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528192853 NPI number — CATHOLIC SOCIAL SERVICES OF LENAWEE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC SOCIAL SERVICES OF LENAWEE COUNTY
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:
1528192853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 N BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADRIAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-263-2191
Provider Business Mailing Address Fax Number:
517-264-6080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADRIAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-263-2191
Provider Business Practice Location Address Fax Number:
517-264-6080
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
517-263-2191

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  460068 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 125095 . This is a "GREAT LAKES HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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