Basic Information
| Provider Information | |||||||||
| NPI: | 1881932275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HJG FARM LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10 | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488540010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176769788 | ||||||||
| FaxNumber: | 5176763438 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 S BRIDGE ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | DEWITT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488208825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172770200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2013 | ||||||||
| LastUpdateDate: | 01/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | GLEW | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5172905648 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801085158 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.