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General NPI Number Information
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NPI Number | 1710709175
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Entity Type | Organization
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Legal Business Name | BAY CITY CRU, LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 3282 E NORTH UNION RD
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City | BAY CITY
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State | MI
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Zip | 48706-2530
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Country | US
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Telephone | 989-391-9036
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Fax | 989-391-9038
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Provider Business Mailing Address
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Address Line | 4424 WINTERWOOD LN
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City | SAGINAW
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State | MI
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Zip | 48603-8673
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Country | US
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Telephone | 989-493-1451
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Fax | 989-401-2876
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | JILL LEBOURDAIS
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Credential | PA-C
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Telephone | 989-493-1451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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