Healthcare Provider Details

I. General information

NPI: 1700901246
Provider Name (Legal Business Name): FAMILY HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 RUSSELL ST
KALAMAZOO MI
49001-3037
US

IV. Provider business mailing address

117 W PATERSON ST
KALAMAZOO MI
49007-2557
US

V. Phone/Fax

Practice location:
  • Phone: 269-377-1702
  • Fax:
Mailing address:
  • Phone: 269-349-2641
  • Fax: 269-488-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801046074
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301063404
License Number StateMI

VIII. Authorized Official

Name: MS. DENISE R CRAWFORD
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 269-349-4257