Provider Demographics
NPI:1316059850
Name:INCORPORATION TO MAXIMIZE PERSONAL ACHIEVEMENT WITH COMMUNITY TRAINING
Entity type:Organization
Organization Name:INCORPORATION TO MAXIMIZE PERSONAL ACHIEVEMENT WITH COMMUNITY TRAINING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:810-985-5437
Mailing Address - Street 1:1001 MILITARY STREET
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-985-5437
Mailing Address - Fax:800-248-1568
Practice Address - Street 1:1001 MILITARY STREET
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-985-5437
Practice Address - Fax:800-248-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P11060Medicare PIN
MI0P03890Medicare PIN