Healthcare Provider Details

I. General information

NPI: 1831402684
Provider Name (Legal Business Name): URBAN HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E KEARSLEY ST 1153 WILLIAM S. WHITE BUILDING
FLINT MI
48502-1907
US

IV. Provider business mailing address

303 E KEARSLEY ST 1153 WILLIAM S. WHITE BUILDING
FLINT MI
48502-1907
US

V. Phone/Fax

Practice location:
  • Phone: 810-424-5269
  • Fax: 810-424-5288
Mailing address:
  • Phone: 810-424-5269
  • Fax: 810-424-5288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number4301063412
License Number StateMI

VIII. Authorized Official

Name: SUSAN SCHNEBERGER
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: LMSW, ACSW, JD
Phone: 810-424-5366