1881922672 NPI number — ST. ANN CORPORATION DBA BRIGHTSTAR OF NORTHERN MICHIGAN

Table of content: (NPI 1881922672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881922672 NPI number — ST. ANN CORPORATION DBA BRIGHTSTAR OF NORTHERN MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. ANN CORPORATION DBA BRIGHTSTAR OF NORTHERN MICHIGAN
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:
1881922672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 W 14TH ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-4060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-929-7827
Provider Business Mailing Address Fax Number:
231-929-7829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 W 14TH ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49684-4060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-929-7827
Provider Business Practice Location Address Fax Number:
231-929-7829
Provider Enumeration Date:
12/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZIMMERMAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
231-929-7827

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com