Provider Demographics
NPI:1649717265
Name:VOLUNTEERS OF AMERICA MICHIGAN
Entity type:Organization
Organization Name:VOLUNTEERS OF AMERICA MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-489-5277
Mailing Address - Street 1:414 N LARCH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1208
Mailing Address - Country:US
Mailing Address - Phone:517-489-5277
Mailing Address - Fax:
Practice Address - Street 1:414 N LARCH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1208
Practice Address - Country:US
Practice Address - Phone:517-489-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOLUNTEERS OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-20
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1750700456122300000X
MI1184760365122300000X
MI1316067002122300000X
MI1295280022124Q00000X
MI1952380412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty