Organization
MCLAREN PORT HURON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SCOTT CECAVA (CEO)
(810) 989-3704
Entity
Organization
Contact information
Practice address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 987-5000
Mailing address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
283Q00000X
Psychiatric Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301557730
—
MI
05
—
40-5171682
—
MI
Enumeration date
11/15/2006
Last updated
04/15/2022
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