Provider Demographics
NPI:1063660199
Name:CATHOLIC SOCIAL SERVICES OF THE U.P.
Entity Type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES OF THE U.P.
Other - Org Name:CATHOLIC CHARITIES OF THE UPPER PENINSULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIOMKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-227-9116
Mailing Address - Street 1:427 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3458
Mailing Address - Country:US
Mailing Address - Phone:906-774-3323
Mailing Address - Fax:906-774-2556
Practice Address - Street 1:510 BRADY AVE.
Practice Address - Street 2:
Practice Address - City:CASPIAN
Practice Address - State:MI
Practice Address - Zip Code:49915
Practice Address - Country:US
Practice Address - Phone:906-265-5097
Practice Address - Fax:906-265-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509106980OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI7509106980OtherBLUE CROSS BLUE SHIELD OF MICHIGAN