Healthcare Provider Details

I. General information

NPI: 1619230471
Provider Name (Legal Business Name): COMMUNITY PREVENTION TREATMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W CHICAGO ST
JONESVILLE MI
49250-1111
US

IV. Provider business mailing address

401 W CHICAGO ST
JONESVILLE MI
49250-1111
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-2333
  • Fax: 517-849-2906
Mailing address:
  • Phone: 517-849-2333
  • Fax: 517-849-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ROY VARGAS
Title or Position: DIRECTOR
Credential: LLMSW, CCS
Phone: 517-849-2330