Healthcare Provider Details

I. General information

NPI: 1891951299
Provider Name (Legal Business Name): MACOMB COUNTY COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21885 DUNHAM RD STE.1
CLINTON TWP MI
48036-1030
US

IV. Provider business mailing address

22550 HALL RD
CLINTON TWP MI
48036-1189
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-5950
  • Fax:
Mailing address:
  • Phone: 586-469-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4704075677
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4704075677
License Number StateMI

VIII. Authorized Official

Name: MR. DONALD HABKIRK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 586-469-6528