Provider Demographics
NPI:1255783254
Name:WAI-IAM, INC.
Entity type:Organization
Organization Name:WAI-IAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBNER
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:517-897-9001
Mailing Address - Street 1:217 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48933-1033
Mailing Address - Country:US
Mailing Address - Phone:517-897-9001
Mailing Address - Fax:517-580-7128
Practice Address - Street 1:217 N SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-1033
Practice Address - Country:US
Practice Address - Phone:517-819-6569
Practice Address - Fax:517-580-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM318510324500000X
MISA0330351324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM318510OtherSUPPORTIVE RECOVERY HOUSING