Healthcare Provider Details

I. General information

NPI: 1013703958
Provider Name (Legal Business Name): NORTHERN MICHIGAN CHILDRENS ASSESSMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S 4TH ST
ROSCOMMON MI
48653-8904
US

IV. Provider business mailing address

PO BOX 887
ROSCOMMON MI
48653-0887
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-7145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: REBECCA YUNCKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-275-7143