Healthcare Provider Details

I. General information

NPI: 1841748688
Provider Name (Legal Business Name): HOLY FAMILY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E MAIN ST
HARTFORD MI
49057-1120
US

IV. Provider business mailing address

2 E MAIN ST
HARTFORD MI
49057-1120
US

V. Phone/Fax

Practice location:
  • Phone: 269-621-0011
  • Fax: 269-308-3336
Mailing address:
  • Phone: 269-621-0011
  • Fax: 269-308-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNIE BOUCHARD
Title or Position: PRESIDENT
Credential:
Phone: 269-621-0011