Provider Demographics
NPI:1417080813
Name:WESTERN UPPER PENINSULA SUBSTANCE ABUSE SERVICES COORDINATING AGENCY
Entity Type:Organization
Organization Name:WESTERN UPPER PENINSULA SUBSTANCE ABUSE SERVICES COORDINATING AGENCY
Other - Org Name:WESTERN UP SUBSTANCE ABUSE SERVICES CA
Other - Org Type:Other Name
Authorized Official - Title/Position:GOVERNING BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-482-7710
Mailing Address - Street 1:902 WEST SHARON AVE.
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931
Mailing Address - Country:US
Mailing Address - Phone:906-482-7710
Mailing Address - Fax:906-482-3217
Practice Address - Street 1:902 WEST SHARON AVE.
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931
Practice Address - Country:US
Practice Address - Phone:906-482-7710
Practice Address - Fax:906-482-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI310030251B00000X
MI220014251B00000X
MI270025251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management