Healthcare Provider Details

I. General information

NPI: 1063409480
Provider Name (Legal Business Name): LUTHERAN CHILD AND FAMILY SERVICE OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WESTSIDE SAGINAW RD
BAY CITY MI
48706-9357
US

IV. Provider business mailing address

6019 WESTSIDE SAGINAW RD P.O. BOX 48
BAY CITY MI
48706-9357
US

V. Phone/Fax

Practice location:
  • Phone: 989-686-7650
  • Fax: 989-686-7688
Mailing address:
  • Phone: 989-686-7650
  • Fax: 989-686-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4422590
License Number StateMI

VIII. Authorized Official

Name: MS. JANINE A JANKOWSKI
Title or Position: ACCOUNTING CLERK
Credential:
Phone: 989-686-7650