Healthcare Provider Details

I. General information

NPI: 1215016449
Provider Name (Legal Business Name): OTTAWA COUNTY CMH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 W RANDALL ST
COOPERSVILLE MI
49404-1307
US

IV. Provider business mailing address

12265 JAMES ST
HOLLAND MI
49424-8613
US

V. Phone/Fax

Practice location:
  • Phone: 616-837-8171
  • Fax: 616-837-5823
Mailing address:
  • Phone: 616-393-5641
  • Fax: 616-393-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GERARD CYRANOWSKI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-393-5649