Healthcare Provider Details

I. General information

NPI: 1831466465
Provider Name (Legal Business Name): DEGEER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7886 MCKINLEY AVE
LAKE MI
48632-9207
US

IV. Provider business mailing address

7050 BEAVERTON RD
LAKE MI
48632-9209
US

V. Phone/Fax

Practice location:
  • Phone: 989-544-2756
  • Fax:
Mailing address:
  • Phone: 989-544-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberAS180264963
License Number StateMI

VIII. Authorized Official

Name: MR. JOEL DEGEER JR.
Title or Position: PRESIDENT
Credential:
Phone: 989-544-3605