Basic Information
| Provider Information | |||||||||
| NPI: | 1902163207 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHIGAN CORE CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3061 CHRISTY WAY | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897912455 | ||||||||
| FaxNumber: | 9897911392 | ||||||||
| Practice Location | |||||||||
| Address1: | 3085 HALLMARK CT | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486036803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897905990 | ||||||||
| FaxNumber: | 9897905991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2012 | ||||||||
| LastUpdateDate: | 06/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | STEWART | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | RANAE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9897905990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801086254 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.