Healthcare Provider Details

I. General information

NPI: 1194736587
Provider Name (Legal Business Name): STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 OAKLAND DR
KALAMAZOO MI
49008-1205
US

IV. Provider business mailing address

1312 OAKLAND DR
KALAMAZOO MI
49008-1205
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-3106
  • Fax: 269-337-3121
Mailing address:
  • Phone: 269-337-3106
  • Fax: 269-337-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GORDY NORRIS
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 269-337-3048