Basic Information
| Provider Information | |||||||||
| NPI: | 1689947996 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOLY CROSS YOUTH AND FAMILY SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | KAIROS HEALTHCARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8759 CLINTON MACON RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492369572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174237556 | ||||||||
| FaxNumber: | 5174235442 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 S WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486014958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897551702 | ||||||||
| FaxNumber: | 9897551401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BAUDOUX | ||||||||
| AuthorizedOfficialFirstName: | PAULINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL OFFICE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 9895963558 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 730230 | MI | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 324500000X | SA0090080 | MI | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 324500000X | SA0250383 | MI | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 324500000X | SA0330349 | MI | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 3245S0500X | 730229 | MI | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
No ID Information.