1821716770 NPI number — MEDICAL BEHAVIORAL HOSPITAL OF MICHIGAN

Table of content: DR. WENDY KREIDER D.C. (NPI 1013115377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821716770 NPI number — MEDICAL BEHAVIORAL HOSPITAL OF MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL BEHAVIORAL HOSPITAL OF MICHIGAN
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:
1821716770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 W JEFFERSON BLVD STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46601-1921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-277-2630
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5802 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49009-9603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-277-2630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BURROUGHS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
574-315-4610

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com