Provider Demographics
NPI:1578707592
Name:NORTHEAST MICHIGAN COMMUNITY SERVICE AGENCY, INC.
Entity Type:Organization
Organization Name:NORTHEAST MICHIGAN COMMUNITY SERVICE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-3474
Mailing Address - Street 1:2375 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4627
Mailing Address - Country:US
Mailing Address - Phone:989-356-3474
Mailing Address - Fax:989-354-6913
Practice Address - Street 1:2375 GORDON RD
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4627
Practice Address - Country:US
Practice Address - Phone:989-356-3474
Practice Address - Fax:989-354-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4508873Medicaid