Provider Demographics
NPI:1316076631
Name:PUBLIC PROTECTION LLC
Entity type:Organization
Organization Name:PUBLIC PROTECTION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:ICADC, HS-BCP, CADC
Authorized Official - Phone:231-733-9800
Mailing Address - Street 1:84 S SEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3841
Mailing Address - Country:US
Mailing Address - Phone:231-733-9800
Mailing Address - Fax:231-733-1949
Practice Address - Street 1:84 S SEAWAY DR
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3841
Practice Address - Country:US
Practice Address - Phone:231-733-9800
Practice Address - Fax:231-733-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104040101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316076631Medicaid