Provider Demographics
NPI:1699378216
Name:CATHOLIC CHARITIES WEST MICHIGAN
Entity type:Organization
Organization Name:CATHOLIC CHARITIES WEST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PLOOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-356-6244
Mailing Address - Street 1:40 JEFFERSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4304
Mailing Address - Country:US
Mailing Address - Phone:616-356-6244
Mailing Address - Fax:
Practice Address - Street 1:1713 7TH ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2426
Practice Address - Country:US
Practice Address - Phone:231-726-4735
Practice Address - Fax:231-727-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility