Healthcare Provider Details

I. General information

NPI: 1518159169
Provider Name (Legal Business Name): ELLA E M BROWN CHARITABLE CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S HILLSDALE ST
HOMER MI
49245-1248
US

IV. Provider business mailing address

300 B DR N
ALBION MI
49224-8420
US

V. Phone/Fax

Practice location:
  • Phone: 517-568-4481
  • Fax:
Mailing address:
  • Phone: 517-629-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name: MICHELE DESMET
Title or Position: FINANCIAL PLANNING & REIMBURSEMENT
Credential:
Phone: 269-781-4271