Healthcare Provider Details

I. General information

NPI: 1760462253
Provider Name (Legal Business Name): COUNTY OF MACOMB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43525 ELIZABETH ST
MOUNT CLEMENS MI
48043-1034
US

IV. Provider business mailing address

43525 ELIZABETH ST
MOUNT CLEMENS MI
48043-1034
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-5235
  • Fax: 586-469-5885
Mailing address:
  • Phone: 586-469-5235
  • Fax: 586-469-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number4301052675
License Number StateMI

VIII. Authorized Official

Name: MR. KEVIN P. LOKAR I
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 586-469-5512