Provider Demographics
NPI:1275182917
Name:CHIPPEWA LUCE MACKINAC COMMUNITY ACTION HUMAN RESOURCE AUTHORITY
Entity Type:Organization
Organization Name:CHIPPEWA LUCE MACKINAC COMMUNITY ACTION HUMAN RESOURCE AUTHORITY
Other - Org Name:CHIPPEWA LUCE MACKINAC COMMUNITY ACTION AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-632-3363
Mailing Address - Street 1:524 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1908
Mailing Address - Country:US
Mailing Address - Phone:906-632-3363
Mailing Address - Fax:
Practice Address - Street 1:524 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1908
Practice Address - Country:US
Practice Address - Phone:906-632-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care