Provider Demographics
NPI:1528118486
Name:MICHIGAN COMPREHENSIVE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:MICHIGAN COMPREHENSIVE HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:248-338-1050
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-0122
Mailing Address - Country:US
Mailing Address - Phone:248-338-1050
Mailing Address - Fax:
Practice Address - Street 1:1280 EDISON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0026
Practice Address - Country:US
Practice Address - Phone:248-338-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN COMPREHENSIVE HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-11
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001609251C00000X
MI6801008434251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11644968OtherCAQH