Healthcare Provider Details

I. General information

NPI: 1649561697
Provider Name (Legal Business Name): COMMUNITY PREVENTION AND TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W. CHICAGO RD.
JONESVILLE MI
49250
US

IV. Provider business mailing address

401 W. CHICAGO RD.
JONESVILLE MI
49250
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-2330
  • Fax: 517-849-2906
Mailing address:
  • Phone: 517-849-2330
  • Fax: 517-849-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300027
License Number StateMI

VIII. Authorized Official

Name: MR. ROY VARGAS
Title or Position: PRESIDENT
Credential: MSW, CAADC
Phone: 517-849-2330