Provider Demographics
NPI:1023059920
Name:MONROE HEALTH VENTURES, INC
Entity type:Organization
Organization Name:MONROE HEALTH VENTURES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:JACKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-240-4527
Mailing Address - Street 1:718 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162
Mailing Address - Country:US
Mailing Address - Phone:734-240-4520
Mailing Address - Fax:734-240-4535
Practice Address - Street 1:100 POWELL DR SUITE 1
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131
Practice Address - Country:US
Practice Address - Phone:734-240-3333
Practice Address - Fax:734-240-3334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY MEMORIAL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
MI5301008257333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2367856OtherOTHER ID NUMBER-COMMERCIAL NUMBER