Healthcare Provider Details

I. General information

NPI: 1043431240
Provider Name (Legal Business Name): WESTERN MICHIGAN UNIVERSITY CENTER FOR DISABILITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OAKLAND DR 3RD FLOOR
KALAMAZOO MI
49008-1282
US

IV. Provider business mailing address

1000 OAKLAND DR 3RD FLOOR
KALAMAZOO MI
49008-1282
US

V. Phone/Fax

Practice location:
  • Phone: 269-387-7200
  • Fax: 269-387-7212
Mailing address:
  • Phone: 269-387-7200
  • Fax: 269-387-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA PEREZ
Title or Position: DIRECTOR
Credential: PHD, BCBA
Phone: 269-387-7412