Basic Information
| Provider Information | |||||||||
| NPI: | 1043942725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | CHRYSTAL | ||||||||
| MiddleName: | SHAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4914 ANGLERS LN | ||||||||
| Address2: | |||||||||
| City: | GLADWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486247625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893022533 | ||||||||
| FaxNumber: | 9897735368 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 S CRAPO ST | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897725930 | ||||||||
| FaxNumber: | 9897735368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.