Provider Demographics
NPI:1518116086
Name:CATHOLIC SOCIAL SERVICES OF THE UP
Entity Type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES OF THE UP
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:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-227-9116
Mailing Address - Street 1:347 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4725
Mailing Address - Country:US
Mailing Address - Phone:906-227-9119
Mailing Address - Fax:906-228-2469
Practice Address - Street 1:347 ROCK ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4725
Practice Address - Country:US
Practice Address - Phone:906-227-9119
Practice Address - Fax:906-228-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509105340OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0P34440Medicare PIN