Healthcare Provider Details

I. General information

NPI: 1851824809
Provider Name (Legal Business Name): MCCULLOUGH VARGAS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 READING AVE
JONESVILLE MI
49250-1136
US

IV. Provider business mailing address

110 READING AVE
JONESVILLE MI
49250-1136
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSA0300027
License Number StateMI

VIII. Authorized Official

Name: GARY MCCULLOUGH
Title or Position: EXEUTIVE DIRECTOR
Credential: CADC
Phone: 517-264-2244