Provider Demographics
NPI:1023275328
Name:EASTERSEALS MORC HEALTH CARE, INC.
Entity type:Organization
Organization Name:EASTERSEALS MORC HEALTH CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-475-6400
Mailing Address - Street 1:2399 E WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-1955
Mailing Address - Country:US
Mailing Address - Phone:248-475-6400
Mailing Address - Fax:248-475-6402
Practice Address - Street 1:1420 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-6208
Practice Address - Country:US
Practice Address - Phone:810-238-0475
Practice Address - Fax:810-238-9270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERSEALS MORC HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N26360Medicare PIN