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General NPI Number Information
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NPI Number | 1801602438
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Entity Type | Organization
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Legal Business Name | BAY PINES CENTER
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2425 N 30TH ST
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City | ESCANABA
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State | MI
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Zip | 49829-9203
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Country | US
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Telephone | 906-789-1232
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Fax | 906-789-9848
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Provider Business Mailing Address
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Address Line | 2425 N 30TH ST
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City | ESCANABA
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State | MI
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Zip | 49829-9203
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Country | US
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Telephone | 906-789-1232
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Fax | 906-789-9848
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Authorized Official
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Title or Position | WOC DIRECTOR
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Name | PATRICK CLANCY MCKEAGE
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Credential |
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Telephone | 906-789-7362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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