Organization Active NPI

Domestic Violence Alternative Program LC

  • Community/Behavioral Health Agency
  • Adrian, MI
National Provider Identifier
1033530423
Registry record updated Jan 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1033348925 Issued in MI
Legal business name
DOMESTIC VIOLENCE ALTERNATIVE PROGRAM LC
Practice address
131 S Winter St
Adrian, MI 49221-2602
Phone
(517) 215-1798
NPI assigned
Jan 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John Clark Bailey, LMSW
Title
Director
Phone
(517) 215-1798

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1033348925 MI Primary

Addresses

Primary practice location

131 S Winter St
Adrian, MI 49221-2602

Mailing address

131 S Winter St
Adrian, MI 49221-2602
Phone (517) 215-1798

Other identifiers 1

IdentifierTypeStateIssuer
1033348925MedicaidMI

National Provider Directory

National Provider Directory
Tax ID family
Domestic Violence Alternative Program LC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388620800000",
    "number": "1033530423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 S WINTER ST",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492212602",
            "telephone_number": "517-215-1798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 S WINTER ST",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492212602",
            "telephone_number": "517-215-1798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMESTIC VIOLENCE ALTERNATIVE PROGRAM LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "last_updated": "2014-01-02",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "517-215-1798",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "1033348925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033348925",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Adrian, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.