Provider Demographics
NPI:1629059563
Name:BON SECOURS PLACE AT ST. CLAIR SHORES
Entity Type:Organization
Organization Name:BON SECOURS PLACE AT ST. CLAIR SHORES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETCHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-498-4501
Mailing Address - Street 1:26101 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2348
Mailing Address - Country:US
Mailing Address - Phone:586-498-4500
Mailing Address - Fax:586-498-4599
Practice Address - Street 1:26101 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2348
Practice Address - Country:US
Practice Address - Phone:586-498-4500
Practice Address - Fax:586-498-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization