Healthcare Provider Details

I. General information

NPI: 1629056486
Provider Name (Legal Business Name): MACOMB COUNTY HUMAN SERVICES BOARD-AN AGENCY OF MACOMB COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43533 ELIZABETH ST
MOUNT CLEMENS MI
48043-1034
US

IV. Provider business mailing address

43533 ELIZABETH ST
MOUNT CLEMENS MI
48043-1034
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-5265
  • Fax: 586-466-7418
Mailing address:
  • Phone: 586-469-5265
  • Fax: 586-466-7418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number508510
License Number StateMI

VIII. Authorized Official

Name: JENNIFER MORGAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 586-469-5623