1568675817 NPI number — BON SECOURS COTTAGE HEALTH SERVICES

Table of content: DR. EVELYN WINFORD COLLIER D.M.D. (NPI 1407979107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568675817 NPI number — BON SECOURS COTTAGE HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON SECOURS COTTAGE 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:
1568675817
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:
2111 VAN ANTWERP ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE WOODS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-1624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-213-8505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
159 KERCHEVAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROSSE POINTE FARMS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236-3610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-640-2537
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALTOMARE
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
VAL
Authorized Official Title or Position:
SUPERVISOR PSYCHIATRIC INTAKE
Authorized Official Telephone Number:
313-640-2537

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  6801076906 , 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)





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