Basic Information
| Provider Information | |||||||||
| NPI: | 1972860005 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMARITAS LUTHERAN SOCIAL SERVICES OF MICHIGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8131 E JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482142610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693455776 | ||||||||
| FaxNumber: | 2693454011 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 S COCHRAN AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488131510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173259090 | ||||||||
| FaxNumber: | 5173259091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | CEDERSTROM | ||||||||
| AuthorizedOfficialFirstName: | JENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3133082764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 104100000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 2084A0401X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 251S00000X | N | Agencies | Community/Behavioral Health | 253J00000X | CB390258392 | MI | N | Agencies | Foster Care Agency | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.