Healthcare Provider Details

I. General information

NPI: 1932309945
Provider Name (Legal Business Name): VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57418 COUNTY ROAD 681
HARTFORD MI
49057-9421
US

IV. Provider business mailing address

801 HAZEN ST SUITE B
PAW PAW MI
49079-2008
US

V. Phone/Fax

Practice location:
  • Phone: 269-621-3143
  • Fax: 269-621-2725
Mailing address:
  • Phone: 269-657-5596
  • Fax: 269-657-5866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number800028
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID FRANK FATZINGER
Title or Position: DIRECTOR, SUBSTANCE ABUSE SERVICES
Credential: ED.D.
Phone: 269-621-3143