Provider Demographics
NPI:1629307822
Name:INTERFACE CONSULTATION SERVICES
Entity Type:Organization
Organization Name:INTERFACE CONSULTATION SERVICES
Other - Org Name:PASSAGES
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:269-929-1292
Mailing Address - Street 1:151 EMMETT ST E
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3319
Mailing Address - Country:US
Mailing Address - Phone:269-929-1292
Mailing Address - Fax:269-965-5267
Practice Address - Street 1:151 EMMETT ST E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3319
Practice Address - Country:US
Practice Address - Phone:269-929-1292
Practice Address - Fax:269-965-5267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERFACE CONSULTATION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management