Healthcare Provider Details

I. General information

NPI: 1275182917
Provider Name (Legal Business Name): CHIPPEWA LUCE MACKINAC COMMUNITY ACTION HUMAN RESOURCE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 ASHMUN ST
SAULT SAINTE MARIE MI
49783-1908
US

IV. Provider business mailing address

524 ASHMUN ST
SAULT SAINTE MARIE MI
49783-1908
US

V. Phone/Fax

Practice location:
  • Phone: 906-632-3363
  • Fax:
Mailing address:
  • Phone: 906-632-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE NOLAN
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 906-632-3363