Provider Demographics
NPI:1144592270
Name:CENCARE FOSTER CARE HOME, INC
Entity Type:Organization
Organization Name:CENCARE FOSTER CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:OLIVIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-773-6200
Mailing Address - Street 1:1933 CHURCHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9101
Mailing Address - Country:US
Mailing Address - Phone:989-773-6200
Mailing Address - Fax:989-772-5389
Practice Address - Street 1:1933 CHURCHILL BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9101
Practice Address - Country:US
Practice Address - Phone:989-773-6200
Practice Address - Fax:989-772-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency