Provider Demographics
NPI:1235360231
Name:EASTER SEALS
Entity Type:Organization
Organization Name:EASTER SEALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA MONIKA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:ROTUNNO
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:989-980-0765
Mailing Address - Street 1:309 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1420 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-6208
Practice Address - Country:US
Practice Address - Phone:810-238-0475
Practice Address - Fax:810-238-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802874448251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management