Provider Demographics
NPI:1902950025
Name:HOLY CROSS SERVIES
Entity Type:Organization
Organization Name:HOLY CROSS SERVIES
Other - Org Name:HOLY CROSS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOISTENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-880-3393
Mailing Address - Street 1:1030 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-6832
Mailing Address - Country:US
Mailing Address - Phone:989-596-3557
Mailing Address - Fax:
Practice Address - Street 1:925 N RIVER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-6831
Practice Address - Country:US
Practice Address - Phone:989-781-2780
Practice Address - Fax:989-781-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
MISA0730229324500000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No251V00000XAgenciesVoluntary or Charitable
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility