Provider Demographics
NPI:1053590935
Name:ST. CLAIR COUNTY SHERIFF
Entity type:Organization
Organization Name:ST. CLAIR COUNTY SHERIFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SERVICES COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRANCH-GADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-966-1625
Mailing Address - Street 1:1170 MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4658
Mailing Address - Country:US
Mailing Address - Phone:810-966-1625
Mailing Address - Fax:810-966-4306
Practice Address - Street 1:1170 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4658
Practice Address - Country:US
Practice Address - Phone:810-966-1625
Practice Address - Fax:810-966-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health