Provider Demographics
NPI:1205977824
Name:CRUZ HEARING AID SERVICE, INC
Entity type:Organization
Organization Name:CRUZ HEARING AID SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRES.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-889-5095
Mailing Address - Street 1:25882 ORCHARD LAKE RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336
Mailing Address - Country:US
Mailing Address - Phone:248-474-8161
Mailing Address - Fax:248-474-2966
Practice Address - Street 1:25882 ORCHARD LAKE RD.
Practice Address - Street 2:SUITE 103
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-474-8161
Practice Address - Fax:248-474-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501001920237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540F30608OtherBCBSM
MI2894672Medicaid