Healthcare Provider Details

I. General information

NPI: 1780011890
Provider Name (Legal Business Name): VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HAZEN ST SUITE C
PAW PAW MI
49079-2008
US

IV. Provider business mailing address

801 HAZEN ST SUITE C
PAW PAW MI
49079-2008
US

V. Phone/Fax

Practice location:
  • Phone: 269-657-5574
  • Fax:
Mailing address:
  • Phone: 269-657-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DEBRA HESS
Title or Position: CEO/CEO
Credential:
Phone: 269-657-5574