Wallace Street Partners LLC

Key facts

NPI

1093255804

Entity type

Organization (NPI type 2)

Primary specialty

Assisted Living Facility (Mental Illness) 3104A0625X

License

AL290252478 (MI)

Legal business name

WALLACE STREET PARTNERS LLC

Practice address

211 W Wallace St
Ashley, MI 48806-9605

Phone

(989) 847-2188

Fax

(989) 847-2183

NPI assigned

Feb 27, 2017

Organization subpart

No

Authorized official

Name

Mrs. Stephanie Lee Seifert, DIPLOMA

Title

Administrator

Phone

(989) 847-2188

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 27, 2017.

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1093255804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W WALLACE ST",
            "city": "ASHLEY",
            "state": "MI",
            "postal_code": "488069605",
            "telephone_number": "989-847-2188",
            "fax_number": "989-847-2183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W WALLACE ST",
            "city": "ASHLEY",
            "state": "MI",
            "postal_code": "488069605",
            "telephone_number": "989-847-2188",
            "fax_number": "989-847-2183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE STREET PARTNERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "SEIFERT",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "989-847-2188",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DIPLOMA"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MI",
            "license": "AL290252478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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