Healthcare Provider Details

I. General information

NPI: 1588722300
Provider Name (Legal Business Name): CENTER FOR FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N JACKSON ST
JACKSON MI
49201-1223
US

IV. Provider business mailing address

505 N JACKSON ST
JACKSON MI
49201-1266
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-5500
  • Fax: 517-780-9286
Mailing address:
  • Phone: 517-748-5500
  • Fax: 517-783-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901008781
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE MAYO
Title or Position: MANAGER
Credential:
Phone: 517-748-5500