Provider Demographics
NPI:1427479369
Name:ALZHEIMER'S DISEASE AND ASSOCIATION, INC
Entity type:Organization
Organization Name:ALZHEIMER'S DISEASE AND ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASEMANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-780-4163
Mailing Address - Street 1:6970 HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2824
Mailing Address - Country:US
Mailing Address - Phone:313-999-5327
Mailing Address - Fax:
Practice Address - Street 1:1125 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4073
Practice Address - Country:US
Practice Address - Phone:810-780-4163
Practice Address - Fax:810-780-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1801097522251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1339Medicare PIN