Healthcare Provider Details

I. General information

NPI: 1508332487
Provider Name (Legal Business Name): EURISKO VOCATIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NILES ROAD SUITE # 7
ST. JOSEPH MI
49085
US

IV. Provider business mailing address

P. BOX 294
BERRIEN SPRINGS MI
49103
US

V. Phone/Fax

Practice location:
  • Phone: 269-281-0407
  • Fax: 269-281-7620
Mailing address:
  • Phone: 269-277-3070
  • Fax: 269-281-7620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ROMMEL JOHNSON
Title or Position: CLINICAL DIRECTOR AND CEO
Credential: MA, LPC, NCC
Phone: 269-277-3070