Provider Demographics
NPI:1417023607
Name:KAIROS HEALTHCARE INCORPORATED
Entity Type:Organization
Organization Name:KAIROS HEALTHCARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:989-777-4357
Mailing Address - Street 1:6379 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48722-9566
Mailing Address - Country:US
Mailing Address - Phone:989-777-4357
Mailing Address - Fax:989-777-7257
Practice Address - Street 1:1321 S FAYETTE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-1447
Practice Address - Country:US
Practice Address - Phone:989-792-8000
Practice Address - Fax:989-792-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI730174324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI328565OtherVALUE OPTIONS PIN
MI543980 1427162239OtherHEALTH ALLIANCE PLAN PIN
MI0K47927OtherHEALTH PLUS PIN
MI14072OtherMCARE PIN