Healthcare Provider Details

I. General information

NPI: 1467710103
Provider Name (Legal Business Name): MICHIGAN COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11238 N ELMS RD
CLIO MI
48420-9447
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 Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAS250072681
License Number StateMI

VIII. Authorized Official

Name: GREG KIRKLAND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 810-635-4407