Healthcare Provider Details

I. General information

NPI: 1043530603
Provider Name (Legal Business Name): JACKSON-HILLSDALE COMMUNITY MENTAL HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N. WEST AVENUE
JACKSON MI
49202
US

IV. Provider business mailing address

1200 N. WEST AVENUE
JACKSON MI
49202
US

V. Phone/Fax

Practice location:
  • Phone: 517-789-1209
  • Fax: 517-796-4532
Mailing address:
  • Phone: 517-780-3332
  • Fax: 517-796-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIBETH LEONARD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 517-789-1208