Provider Demographics
NPI:1396150546
Name:BLUE SEAHORSE INC.
Entity type:Organization
Organization Name:BLUE SEAHORSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-244-3577
Mailing Address - Street 1:101 E DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MI
Mailing Address - Zip Code:49045-1131
Mailing Address - Country:US
Mailing Address - Phone:269-244-3577
Mailing Address - Fax:269-409-3983
Practice Address - Street 1:101 E DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MI
Practice Address - Zip Code:49045-1131
Practice Address - Country:US
Practice Address - Phone:269-244-3577
Practice Address - Fax:269-409-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0800033101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty