| Mclaren Port Huron | |
|
1221 Pine Grove Ave Port Huron MI 48060-3511 | |
| (810) 987-5000 | |
| Not Available |
| Full Name | Mclaren Port Huron |
|---|---|
| Speciality | Psychiatric Hospital |
| Location | 1221 Pine Grove Ave, Port Huron, Michigan |
| Authorized Official Name and Position | Eric Scott Cecava (CEO) |
| Authorized Official Contact | 8109893704 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mclaren Port Huron 1221 Pine Grove Ave Port Huron MI 48060-3511 Ph: () - | Mclaren Port Huron 1221 Pine Grove Ave Port Huron MI 48060-3511 Ph: (810) 987-5000 |
| NPI Number | 1780756627 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 04/15/2022 |
| Certification Date | 04/15/2022 |
| Medicare PECOS PAC ID | 9931018702 |
|---|---|
| Medicare Enrollment ID | O20070212000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780756627 | NPI | - | NPPES |
| 40-5171682 | Medicaid | MI | |
| 301557730 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 283Q00000X | Psychiatric Hospital | (* (Not Available)) | Primary |
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