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General NPI Number Information
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NPI Number | 1255783254
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Entity Type | Organization
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Legal Business Name | WAI-IAM, INC.
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 217 N SYCAMORE ST
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City | LANSING
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State | MI
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Zip | 48933-1033
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Country | US
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Telephone | 517-819-6569
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Fax | 517-580-7128
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Provider Business Mailing Address
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Address Line | 217 N SYCAMORE ST
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City | LANSING
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State | MI
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Zip | 48933-1033
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Country | US
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Telephone | 517-897-9001
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Fax | 517-580-7128
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JACQUELYN LIEBNER
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Credential | BBA
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Telephone | 517-897-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | M318510
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA0330351
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License Number State | MI
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