Provider Demographics
NPI:1194093500
Name:ALHAMBRA ST. FRANCIS CAMP ON THE LAKE
Entity type:Organization
Organization Name:ALHAMBRA ST. FRANCIS CAMP ON THE LAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-218-9345
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-0475
Mailing Address - Country:US
Mailing Address - Phone:517-688-9212
Mailing Address - Fax:517-688-9298
Practice Address - Street 1:10120 MURREY RD
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:MI
Practice Address - Zip Code:49249-9534
Practice Address - Country:US
Practice Address - Phone:517-688-9212
Practice Address - Fax:517-688-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp