Provider Demographics
NPI:1992838619
Name:MID SOUTH SUBSTANCE ABUSE COMMISSION
Entity Type:Organization
Organization Name:MID SOUTH SUBSTANCE ABUSE COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-337-4406
Mailing Address - Street 1:2875 NORTHWIND DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5092
Mailing Address - Country:US
Mailing Address - Phone:517-337-4406
Mailing Address - Fax:517-337-8512
Practice Address - Street 1:2875 NORTHWIND DR
Practice Address - Street 2:SUITE 215
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5092
Practice Address - Country:US
Practice Address - Phone:517-337-4406
Practice Address - Fax:517-337-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder