Basic Information
| Provider Information | |||||||||
| NPI: | 1265527337 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASCENSION BRIGHTON CENTER FOR RECOVERY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | BRIGHTON HOSPITAL | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 12851 GRAND RIVER RD | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481168596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102271211 | ||||||||
| FaxNumber: | 8102271869 | ||||||||
| Practice Location | |||||||||
| Address1: | 12851 GRAND RIVER RD | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481168596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102271211 | ||||||||
| FaxNumber: | 8102271869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JEUP | ||||||||
| AuthorizedOfficialFirstName: | JEAN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMIN ASST MED DEPT | ||||||||
| AuthorizedOfficialTelephone: | 2486808203 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 470001 | MI | N | Hospitals | General Acute Care Hospital | 324500000X | 470001 | MI | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | P100016 | 01 | CARE CHOICE HEALTH PLAN | OTHER | 9000364 | 01 | HEALTH PLUS | OTHER | 100016 | 01 | PREFERRED CHOICE | OTHER | 20350 | 01 | BLUE CARE NETWORK/OTHER | OTHER | 20350 | 01 | MI | BLUE CROSS | OTHER | HL 470001 | 01 | M-CARE | OTHER | 100016-56 | 01 | CARE CHOICE | OTHER | 11-0-D7-1024-0 | 01 | BLUE CARE NETWORK | OTHER | 049284 | 01 | VALUE OPTIONS | OTHER | 11-0-D7-1024-0 | 01 | BLUE CROSS | OTHER | 230279 | 01 | HEALTH ALLIANCE PLAN | OTHER |