Organization Name: | SOUTH COUNTY ENT |
NPI Number: | 1740252535 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY GEEGAN MIDDLETON (EXECUTIVE DIRECTOR) |
Mailing Address: | 60 N Saint Joseph Ave Suite C Niles |
State: | MI US |
Postal Code: | 491202296 |
Phone Number: | 2696872910 |
Fax Number: | 2696878770 |
NPI Enumeration Date: | 02/06/2006 |
NPI Last Update Date: | 11/01/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 4301074195 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |