Provider Demographics
NPI:1679687339
Name:CATHOLIC SOCIAL SERVICES OF WASHTENAW COUNTY
Entity Type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES OF WASHTENAW COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:MCDONAGH
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MA
Authorized Official - Phone:734-926-0154
Mailing Address - Street 1:4925 PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1521
Mailing Address - Country:US
Mailing Address - Phone:734-971-9781
Mailing Address - Fax:734-971-2730
Practice Address - Street 1:4925 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1521
Practice Address - Country:US
Practice Address - Phone:734-971-9781
Practice Address - Fax:734-971-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP24010Medicare ID - Type UnspecifiedMEDICARE ID