Healthcare Provider Details

I. General information

NPI: 1508060682
Provider Name (Legal Business Name): CATHOLIC HUMAN SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 ELKVIEW DR
GAYLORD MI
49735-2055
US

IV. Provider business mailing address

829 W MAIN ST STE C3
GAYLORD MI
49735-1998
US

V. Phone/Fax

Practice location:
  • Phone: 989-732-6761
  • Fax: 989-732-6763
Mailing address:
  • Phone: 989-732-6761
  • Fax: 989-732-6763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number690008
License Number StateMI

VIII. Authorized Official

Name: DAVID R MARTIN
Title or Position: CEO
Credential:
Phone: 231-947-8110