Healthcare Provider Details

I. General information

NPI: 1447912050
Provider Name (Legal Business Name): SHAUN VINING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 COLLEGE ST
BATTLE CREEK MI
49037-3432
US

IV. Provider business mailing address

175 COLLEGE ST
BATTLE CREEK MI
49037-3432
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-1460
  • Fax: 269-966-2844
Mailing address:
  • Phone: 269-966-1460
  • Fax: 269-966-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851115413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: