Provider Demographics
NPI:1861035461
Name:J E LAIRD 1 LLC
Entity Type:Organization
Organization Name:J E LAIRD 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-210-7429
Mailing Address - Street 1:6362 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3503
Mailing Address - Country:US
Mailing Address - Phone:810-210-7429
Mailing Address - Fax:
Practice Address - Street 1:5265 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2461
Practice Address - Country:US
Practice Address - Phone:810-715-9029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-26
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty