Basic Information
| Provider Information | |||||||||
| NPI: | 1194922906 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR FAMILY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 548 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492040548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177843950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 SPRINGPORT RD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492021432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177843950 | ||||||||
| FaxNumber: | 5177832728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMICK | ||||||||
| AuthorizedOfficialFirstName: | SHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PATIENT ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5177843950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 133V00000X | X | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 163W00000X | X | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
No ID Information.