1730300872 NPI number — LUTHERAN SOCIAL SERVICES OF MICHIGAN

Table of content: (NPI 1730300872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730300872 NPI number — LUTHERAN SOCIAL SERVICES OF MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN SOCIAL SERVICES OF 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:
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:
1730300872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8131 E JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48214-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-823-7700
Provider Business Mailing Address Fax Number:
313-823-9604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 FULTON ST E
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-356-1934
Provider Business Practice Location Address Fax Number:
616-356-5779
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCGRATH
Authorized Official First Name:
LOU ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
313-823-7700

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)





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