Healthcare Provider Details

I. General information

NPI: 1093802902
Provider Name (Legal Business Name): VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 M-62 NORTH
CASSOPOLIS MI
49031
US

IV. Provider business mailing address

57418 COUNTY ROAD 681 SUITE A
HARTFORD MI
49057-9421
US

V. Phone/Fax

Practice location:
  • Phone: 269-445-5280
  • Fax: 269-445-5278
Mailing address:
  • Phone: 269-621-3143
  • Fax: 269-621-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY L ELLIOTT
Title or Position: HEALTH OFFICER/ADMINISTRATOR
Credential:
Phone: 269-621-3143