Provider Demographics
NPI:1710709175
Name:BAY CITY CRU, LLC
Entity type:Organization
Organization Name:BAY CITY CRU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOURDAIS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:989-493-1451
Mailing Address - Street 1:4424 WINTERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8673
Mailing Address - Country:US
Mailing Address - Phone:989-493-1451
Mailing Address - Fax:989-401-2876
Practice Address - Street 1:3282 E NORTH UNION RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2530
Practice Address - Country:US
Practice Address - Phone:989-391-9036
Practice Address - Fax:989-391-9038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility