Healthcare Provider Details

I. General information

NPI: 1619907631
Provider Name (Legal Business Name): ST. VINCENT CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W WILLOW ST
LANSING MI
48917-1833
US

IV. Provider business mailing address

2800 W WILLOW ST
LANSING MI
48917-1833
US

V. Phone/Fax

Practice location:
  • Phone: 517-323-4734
  • Fax: 517-886-1150
Mailing address:
  • Phone: 517-323-4734
  • Fax: 517-886-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberC1330266746
License Number StateMI

VIII. Authorized Official

Name: ANDREA SEYKA
Title or Position: CEO
Credential:
Phone: 517-323-4734