Provider Demographics
NPI:1508334764
Name:MARQUETTE STAFFING AGENCY, INC.
Entity Type:Organization
Organization Name:MARQUETTE STAFFING AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WERNHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:906-235-8311
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-0666
Mailing Address - Country:US
Mailing Address - Phone:906-235-8311
Mailing Address - Fax:
Practice Address - Street 1:592 BLEMHUBER AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4818
Practice Address - Country:US
Practice Address - Phone:906-235-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7520051Medicaid