Healthcare Provider Details

I. General information

NPI: 1316059850
Provider Name (Legal Business Name): INCORPORATION TO MAXIMIZE PERSONAL ACHIEVEMENT WITH COMMUNITY TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MILITARY STREET
PORT HURON MI
48060
US

IV. Provider business mailing address

1001 MILITARY STREET
PORT HURON MI
48060
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-5437
  • Fax: 800-248-1568
Mailing address:
  • Phone: 810-985-5437
  • Fax: 800-248-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. HERBERT M. WENDT JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 810-985-5437