Provider Demographics
NPI:1720332265
Name:NEW PASSAGES
Entity Type:Organization
Organization Name:NEW PASSAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-860-5749
Mailing Address - Street 1:175 N. GRORSEBECK HWY
Mailing Address - Street 2:
Mailing Address - City:MT. CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043
Mailing Address - Country:US
Mailing Address - Phone:586-627-0024
Mailing Address - Fax:586-624-0027
Practice Address - Street 1:175 N. GRORSEBECK HWY
Practice Address - Street 2:
Practice Address - City:MT. CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043
Practice Address - Country:US
Practice Address - Phone:586-627-0024
Practice Address - Fax:586-624-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service