Healthcare Provider Details

I. General information

NPI: 1558098319
Provider Name (Legal Business Name): MS. SUSAN HARRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 1ST ST STE 504
JACKSON MI
49203-3034
US

IV. Provider business mailing address

1203 1ST ST STE 504
JACKSON MI
49203-3034
US

V. Phone/Fax

Practice location:
  • Phone: 517-257-2511
  • Fax: 888-323-2176
Mailing address:
  • Phone: 517-257-2511
  • Fax: 888-323-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: