Basic Information
Provider Information
NPI: 1902234123
EntityType: 2
ReplacementNPI:  
OrganizationName: FAMILY HEALTH CENTER, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 117 W PATERSON ST
Address2:  
City: KALAMAZOO
State: MI
PostalCode: 490072557
CountryCode: US
TelephoneNumber: 2693492641
FaxNumber: 2694665522
Practice Location
Address1: 117 W PATERSON ST
Address2:  
City: KALAMAZOO
State: MI
PostalCode: 490072557
CountryCode: US
TelephoneNumber: 2693492641
FaxNumber: 2694665522
Other Information
ProviderEnumerationDate: 10/25/2013
LastUpdateDate: 10/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CHIENG
AuthorizedOfficialFirstName: EILEEN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 2693492641
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM1300X  Y Ambulatory Health Care FacilitiesClinic/CenterMulti-Specialty

No ID Information.


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