Provider Demographics
NPI:1235112616
Name:CATHOLIC SERVICES OF MACOMB
Entity Type:Organization
Organization Name:CATHOLIC SERVICES OF MACOMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THRELOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-416-2300
Mailing Address - Street 1:15945 CANAL RD
Mailing Address - Street 2:PO BOX 380290
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1610
Mailing Address - Country:US
Mailing Address - Phone:586-416-2300
Mailing Address - Fax:586-416-2311
Practice Address - Street 1:15945 CANAL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1610
Practice Address - Country:US
Practice Address - Phone:586-416-2300
Practice Address - Fax:586-416-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P10420Medicare ID - Type Unspecified
MI0M87020Medicare ID - Type Unspecified