SE MICHIGAN SENIOR SERVICES LLC
Complete NPI Record 1164194403
Home Delivered Meals in Pontiac, MI
Active since October 05, 2021
Complete NPI Dataset
This page contains the complete raw NPPES record for Se Michigan Senior Services Llc (NPI 1164194403), a home delivered meals organization in Pontiac, MI. All 32 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
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Registry File Document Utilities
- NPI: 1164194403 Field 1/32
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/32
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/32
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: SE MICHIGAN SENIOR SERVICES LLC Field 4/32
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 6905 TELEGRAPH RD STE 360 Field 5/32
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: BLOOMFIELD HILLS Field 6/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MI Field 7/32
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 483013189 Field 8/32
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/32
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 2485450707 Field 10/32
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 2485450270 Field 11/32
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 1915 BALDWIN AVE Field 12/32
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: PONTIAC Field 13/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MI Field 14/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 483401173 Field 15/32
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 2483357020 Field 17/32
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 2483350141 Field 18/32
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: TISCH Field 21/32
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: JILLIAN Field 22/32
- The first name of the authorized official.
- Authorized Official Middle Name: J Field 23/32
- The middle name of the authorized official.
- Authorized Official Title or Position: AUTHORIZED PERSONNEL Field 24/32
- The title or position of the authorized official.
- Authorized Official Telephone Number: 2485450707 Field 25/32
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 376J00000X Field 26/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 27/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 332U00000X Field 28/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 29/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 30/32
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP Field 31/32
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
Baldwin House Lakeside I, Lakeside II & Oakland Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 2
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
15821 19 Mile Rd
Location 1/2Clinton Township, MI 48038-6320 · Phone (586) 228-8889 · Fax (586) 263-9486
15731 19 Mile Rd
Location 2/2Clinton Township, MI 48038-6315 · Phone (586) 263-0081 · Fax (586) 412-1672
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