Provider Demographics
NPI:1629269378
Name:LUTHERAN SOCIAL SERVICES OF MICHIGAN
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF MICHIGAN
Other - Org Name:MAPLECREEK AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LOUELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-823-7700
Mailing Address - Street 1:8131 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2610
Mailing Address - Country:US
Mailing Address - Phone:313-823-7700
Mailing Address - Fax:313-823-9604
Practice Address - Street 1:2000 32ND ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7910
Practice Address - Country:US
Practice Address - Phone:616-452-6084
Practice Address - Fax:616-452-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health