Provider Demographics
NPI:1881862662
Name:CATHOLIC SOCIAL SERVICES OF THE UPPER PENINSULA
Entity Type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES OF THE UPPER PENINSULA
Other - Org Name:CATHOLIC CHARITIES OF THE UPPER PENINSULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIOMKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-227-9116
Mailing Address - Street 1:616 SHELDEN AVE
Mailing Address - Street 2:STE 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:STE 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:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI310040251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health