Healthcare Provider Details

I. General information

NPI: 1043605876
Provider Name (Legal Business Name): MICHIGAN COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 N SAGINAW RD
CLIO MI
48420-2703
US

IV. Provider business mailing address

PO BOX 317
SWARTZ CREEK MI
48473-0317
US

V. Phone/Fax

Practice location:
  • Phone: 810-635-4407
  • Fax: 810-635-4086
Mailing address:
  • Phone: 810-635-4407
  • Fax: 810-635-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN EDWARDS
Title or Position: BOOKKEEPER
Credential:
Phone: 810-635-4407