Provider Demographics
NPI:1619907631
Name:ST. VINCENT CATHOLIC CHARITIES
Entity Type:Organization
Organization Name:ST. VINCENT CATHOLIC CHARITIES
Other - Org Name:CATHOLIC SOCIAL SERVICES OF LANSING/ST. VINCENT HOME, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-323-4734
Mailing Address - Street 1:2800 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1833
Mailing Address - Country:US
Mailing Address - Phone:517-323-4734
Mailing Address - Fax:517-886-1150
Practice Address - Street 1:2800 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1833
Practice Address - Country:US
Practice Address - Phone:517-323-4734
Practice Address - Fax:517-886-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
MIC1330266746322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C36108Medicare PIN