Healthcare Provider Details

I. General information

NPI: 1730300872
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FULTON ST E 4TH FLOOR
GRAND RAPIDS MI
49503-3210
US

IV. Provider business mailing address

8131 E JEFFERSON AVE
DETROIT MI
48214-2610
US

V. Phone/Fax

Practice location:
  • Phone: 616-356-1934
  • Fax: 616-356-5779
Mailing address:
  • Phone: 313-823-7700
  • Fax: 313-823-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LOU ELLEN MCGRATH
Title or Position: CFO
Credential:
Phone: 313-823-7700