Provider Demographics
NPI:1902154958
Name:COMPREHENSIVE SENIOR CARE CORPORATION
Entity Type:Organization
Organization Name:COMPREHENSIVE SENIOR CARE CORPORATION
Other - Org Name:CENTRACARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:ELIZABETH GREEN
Authorized Official - Last Name:LUETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-441-9332
Mailing Address - Street 1:200 MICHIGAN AVE W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3607
Mailing Address - Country:US
Mailing Address - Phone:269-441-9300
Mailing Address - Fax:269-441-3487
Practice Address - Street 1:200 MICHIGAN AVE W
Practice Address - Street 2:SUITE 103
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3607
Practice Address - Country:US
Practice Address - Phone:269-441-9300
Practice Address - Fax:269-441-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802069397305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization