Healthcare Provider Details

I. General information

NPI: 1760645386
Provider Name (Legal Business Name): COMPREHENSIVE SENIOR CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MICHIGAN AVE W SUITE 103
BATTLE CREEK MI
49017-3607
US

IV. Provider business mailing address

200 MICHIGAN AVE W SUITE 103
BATTLE CREEK MI
49017-3607
US

V. Phone/Fax

Practice location:
  • Phone: 269-441-9315
  • Fax: 269-441-9329
Mailing address:
  • Phone: 269-441-9315
  • Fax: 269-441-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA ELIZABETH GREEN LUETH
Title or Position: CEO
Credential:
Phone: 269-441-9332