Healthcare Provider Details

I. General information

NPI: 1063764082
Provider Name (Legal Business Name): BEDFORD SPECIALIZED CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 BYRON ST
BATTLE CREEK MI
49017-4860
US

IV. Provider business mailing address

2775 W DICKMAN RD STE H1
SPRINGFIELD MI
49037-4862
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-7459
  • Fax: 269-968-1196
Mailing address:
  • Phone: 269-753-6027
  • Fax: 269-968-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberAS130095138
License Number StateMI

VIII. Authorized Official

Name: MR. ALAN MICHAEL DYER
Title or Position: PRESIDENT
Credential:
Phone: 269-753-6027