Provider Demographics
NPI:1710209101
Name:BARABE HOME
Entity Type:Organization
Organization Name:BARABE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRIMARY CARE PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAHTI
Authorized Official - Suffix:
Authorized Official - Credentials:STATE LICENSE
Authorized Official - Phone:906-249-8916
Mailing Address - Street 1:156 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-8740
Mailing Address - Country:US
Mailing Address - Phone:906-249-8916
Mailing Address - Fax:
Practice Address - Street 1:156 MILLER RD
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-8740
Practice Address - Country:US
Practice Address - Phone:906-249-8916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF520238291305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAF520238291OtherSTATE OF MICH. DEPT. OF HUMAN SERVICES