Healthcare Provider Details

I. General information

NPI: 1710074448
Provider Name (Legal Business Name): MONTCALM CARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N STATE STREET
STANTON MI
48888
US

IV. Provider business mailing address

611 N STATE STREET
STANTON MI
48888
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-7520
  • Fax: 989-831-7578
Mailing address:
  • Phone: 989-831-7520
  • Fax: 989-831-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES R WISE
Title or Position: ASSOCIATE DIRECTOR OF FINANCE
Credential:
Phone: 989-831-7577