Healthcare Provider Details

I. General information

NPI: 1790192946
Provider Name (Legal Business Name): FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E CROSSTOWN PKWY
KALAMAZOO MI
49001-2501
US

IV. Provider business mailing address

117 W PATERSON ST
KALAMAZOO MI
49007-2557
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-2641
  • Fax:
Mailing address:
  • Phone: 269-349-2641
  • Fax: 269-201-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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