1831709641 NPI number — URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM OF LUCAS CTY

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 1831709641 NPI number — URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM OF LUCAS CTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM OF LUCAS CTY
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:
1831709641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33872 YORKRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48331-1550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-297-2553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2447 NEBRASKA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43607-3531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-255-4444
Provider Business Practice Location Address Fax Number:
419-531-1596
Provider Enumeration Date:
08/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
TERRELL
Authorized Official Middle Name:
RHAJON
Authorized Official Title or Position:
CORPORATE COMPLIANCE
Authorized Official Telephone Number:
419-297-2553

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01-7673 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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