1790053270 NPI number — BAY AREA SUBSTANCE EDUCATION SERVICES

Table of content: (NPI 1790053270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790053270 NPI number — BAY AREA SUBSTANCE EDUCATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA SUBSTANCE EDUCATION 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:
6
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:
1790053270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 M 66 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLEVOIX
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49720-9338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-547-1144
Provider Business Mailing Address Fax Number:
231-547-4970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 M 66 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLEVOIX
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49720-9338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-547-1144
Provider Business Practice Location Address Fax Number:
231-547-4970
Provider Enumeration Date:
12/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PARTIDA KELLY
Authorized Official First Name:
CELIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
231-547-1144

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 150013 , 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: MNPC20131030 . This is a "MCLAREN HEALTH PLAN, MCLAREN MEDICAID, MCLAREN HMO, MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OA50082 . This is a "BCBSM MENTAL HEALTH AND SUBSTANCE ABUSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MIS601220445 . This is a "MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383SYS0617-C . This is a "HUMANA BEHAVIORAL HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MIS601220444 . This is a "MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: COUN18-99599 . This is a "MDHHS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MIS601220443 . This is a "MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 20151209439760 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OA50082 . This is a "BLUE CROSS BLUE SHIELD, TRADITIONAL (10) PAR, PPO TRUST (55)" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000722974 . This is a "OPTUM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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