Provider Demographics
NPI:1336317585
Name:CATHOLIC SOCIAL SERVICES OF THE UPPER PENINSULA
Entity Type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES OF THE UPPER PENINSULA
Other - Org Name:CATHOLIC CHARITIES OF THE UPPER PENINSULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIOMKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-227-9116
Mailing Address - Street 1:1401 N 26TH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-2500
Mailing Address - Country:US
Mailing Address - Phone:906-786-7212
Mailing Address - Fax:906-786-0676
Practice Address - Street 1:1401 N 26TH ST STE 116
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-2500
Practice Address - Country:US
Practice Address - Phone:906-786-7212
Practice Address - Fax:906-786-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801074598251S00000X
MI6801012078251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34440003Medicare PIN
MIP34440002Medicare PIN