Provider Demographics
NPI:1548596216
Name:WOLVERINE HUMAN SERVICES
Entity type:Organization
Organization Name:WOLVERINE HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT LEADER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:BA
Authorized Official - Phone:989-239-2148
Mailing Address - Street 1:1120 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:VASSAR
Mailing Address - State:MI
Mailing Address - Zip Code:48768-9588
Mailing Address - Country:US
Mailing Address - Phone:989-823-7640
Mailing Address - Fax:
Practice Address - Street 1:1120 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:VASSAR
Practice Address - State:MI
Practice Address - Zip Code:48768-9588
Practice Address - Country:US
Practice Address - Phone:989-823-7640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children