Healthcare Provider Details

I. General information

NPI: 1891887816
Provider Name (Legal Business Name): BEARLAKE UNITED METHODIST CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7861 MAIN ST.
BEARLAKE MI
49614-0157
US

IV. Provider business mailing address

7861 MAIN ST.
BEARLAKE MI
49614-0157
US

V. Phone/Fax

Practice location:
  • Phone: 231-864-3680
  • Fax: 231-864-3680
Mailing address:
  • Phone: 231-864-3680
  • Fax: 231-864-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DYE
Title or Position: LOCAL PASTOR
Credential:
Phone: 231-864-3680