Provider Demographics
NPI:1427162239
Name:KAIROS HEALTHCARE INCORPORATED
Entity type:Organization
Organization Name:KAIROS HEALTHCARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:989-777-4357
Mailing Address - Street 1:6379 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48722-9566
Mailing Address - Country:US
Mailing Address - Phone:989-777-4357
Mailing Address - Fax:989-777-7257
Practice Address - Street 1:6379 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9566
Practice Address - Country:US
Practice Address - Phone:989-777-4357
Practice Address - Fax:989-777-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI730157101YA0400X, 104100000X, 324500000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI328565OtherVALUE OPTIONS PIN
MI20520OtherBCBS OF MI
MI0K47927OtherHEALTH PLUS PIN
MI1008848OtherMCCLAREN PIN
MI14072OtherMCARE PIN