Provider Demographics
NPI:1669636544
Name:CATHOLIC SOCIAL SERVICES OF THE UP
Entity Type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES OF THE UP
Other - Org Name:CATHOLIC CHARITIES OF THE UPPER PENINSULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FEATHERSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-227-9118
Mailing Address - Street 1:616 SHELDEN AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1841
Mailing Address - Country:US
Mailing Address - Phone:906-482-1624
Mailing Address - Fax:906-482-8301
Practice Address - Street 1:616 SHELDEN AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1841
Practice Address - Country:US
Practice Address - Phone:906-482-1624
Practice Address - Fax:906-482-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509106790OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0P34440Medicare PIN