Provider Demographics
NPI:1548272586
Name:SHORELINE CONSULTATION SERVICES
Entity type:Organization
Organization Name:SHORELINE CONSULTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-733-5334
Mailing Address - Street 1:1435 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2125
Mailing Address - Country:US
Mailing Address - Phone:231-733-5334
Mailing Address - Fax:231-737-1255
Practice Address - Street 1:1435 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2125
Practice Address - Country:US
Practice Address - Phone:231-733-5334
Practice Address - Fax:231-737-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI610042251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI610042OtherSUBSTANCE ABUSE LICENSE