Healthcare Provider Details

I. General information

NPI: 1992268627
Provider Name (Legal Business Name): KALAMAZOO EMPOWERMENT SERVICES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 KING HWY STE 120
KALAMAZOO MI
49001-2579
US

IV. Provider business mailing address

834 KING HWY STE 120
KALAMAZOO MI
49001-2579
US

V. Phone/Fax

Practice location:
  • Phone: 269-598-2837
  • Fax: 844-279-3926
Mailing address:
  • Phone: 269-598-2837
  • Fax: 844-279-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEANNA F. OMONIYI
Title or Position: OWNER
Credential:
Phone: 269-598-2837