Healthcare Provider Details

I. General information

NPI: 1952858987
Provider Name (Legal Business Name): FAMILY HEALTH & WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 W BROWN ST
BEAVERTON MI
48612-8119
US

IV. Provider business mailing address

129 W BROWN ST
BEAVERTON MI
48612-8119
US

V. Phone/Fax

Practice location:
  • Phone: 989-435-2937
  • Fax: 989-435-3121
Mailing address:
  • Phone: 989-435-2937
  • Fax: 989-435-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number5601004029
License Number StateMI

VIII. Authorized Official

Name: RICHARD A CALL
Title or Position: OWNER
Credential: PH-C
Phone: 989-435-2937