Provider Demographics
NPI:1922019561
Name:CASCADE HEMOPHILIA CONSORTIUM
Entity Type:Organization
Organization Name:CASCADE HEMOPHILIA CONSORTIUM
Other - Org Name:CASCADE HEMOPHILIA CONSORTIUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-996-3300
Mailing Address - Street 1:2025 TRAVERWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2197
Mailing Address - Country:US
Mailing Address - Phone:734-996-3300
Mailing Address - Fax:734-996-5566
Practice Address - Street 1:2025 TRAVERWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2197
Practice Address - Country:US
Practice Address - Phone:734-996-3300
Practice Address - Fax:734-996-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010061553336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2042655OtherPK
MI2353922Medicaid
2353922OtherNCPDP PROVIDER IDENTIFICATION NUMBER