Provider Demographics
NPI:1508010679
Name:SALVATION ARMY HARBOR LIGHT MACOMB
Entity Type:Organization
Organization Name:SALVATION ARMY HARBOR LIGHT MACOMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MAJOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-954-1838
Mailing Address - Street 1:42590 STEPNITZ DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14030 LAKESIDE BLVD N
Practice Address - Street 2:APT C-221
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6050
Practice Address - Country:US
Practice Address - Phone:586-212-7734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-15
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness