Provider Demographics
NPI:1063409480
Name:LUTHERAN CHILD AND FAMILY SERVICE OF MICHIGAN
Entity type:Organization
Organization Name:LUTHERAN CHILD AND FAMILY SERVICE OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-686-7650
Mailing Address - Street 1:6019 WESTSIDE SAGINAW RD
Mailing Address - Street 2:P.O. BOX 48
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9357
Mailing Address - Country:US
Mailing Address - Phone:989-686-7650
Mailing Address - Fax:989-686-7688
Practice Address - Street 1:6019 WESTSIDE SAGINAW RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9357
Practice Address - Country:US
Practice Address - Phone:989-686-7650
Practice Address - Fax:989-686-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4422590251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3270805Medicaid
MI4422590Medicaid
MI2931909Medicaid
MI4611177Medicaid
MI4587821Medicaid