Healthcare Provider Details

I. General information

NPI: 1114040995
Provider Name (Legal Business Name): COMMUNITY HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SHAFFER STREET
KALAMAZOO MI
49048-1604
US

IV. Provider business mailing address

1910 SHAFFER STREET
KALAMAZOO MI
49048-1604
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-9820
  • Fax: 269-345-7190
Mailing address:
  • Phone: 269-382-9820
  • Fax: 269-345-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number390160
License Number StateMI

VIII. Authorized Official

Name: MICHAEL PIOCH
Title or Position: OPERATIONS MANAGER
Credential: BS
Phone: 269-343-1651