Provider Demographics
NPI:1255470472
Name:SOUTHEAST MICHIGAN COMMUNITY ALLIANCE
Entity Type:Organization
Organization Name:SOUTHEAST MICHIGAN COMMUNITY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF INFORMATION OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HELLAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:734-229-3527
Mailing Address - Street 1:25363 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5051
Mailing Address - Country:US
Mailing Address - Phone:734-229-3500
Mailing Address - Fax:734-229-3501
Practice Address - Street 1:25363 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5051
Practice Address - Country:US
Practice Address - Phone:734-229-3500
Practice Address - Fax:734-229-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder