1477815645 NPI number — KALAMAZOO COMMUNITY MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

Table of content: (NPI 1477815645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477815645 NPI number — KALAMAZOO COMMUNITY MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALAMAZOO COMMUNITY MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477815645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3299 GULL RD
Provider Second Line Business Mailing Address:
PO BOX63, W1F4
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49048-1281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-553-8000
Provider Business Mailing Address Fax Number:
269-553-8012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3299 GULL RD
Provider Second Line Business Practice Location Address:
W1F4
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-553-8000
Provider Business Practice Location Address Fax Number:
269-553-8012
Provider Enumeration Date:
06/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SOVA
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
IT DIRECTOR
Authorized Official Telephone Number:
269-553-8000

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  390177 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 390177 . This is a "SUBSTANCE ABUSE LICENSE#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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