Healthcare Provider Details

I. General information

NPI: 1124542063
Provider Name (Legal Business Name): CENTRAL MICHIGAN CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 E BROADWAY ST
MT PLEASANT MI
48858-2933
US

IV. Provider business mailing address

798 S WHITEVILLE RD
MOUNT PLEASANT MI
48858-8776
US

V. Phone/Fax

Practice location:
  • Phone: 989-854-8334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY HUTCHINS
Title or Position: VICE PRESIDENT
Credential:
Phone: 989-854-8334