Healthcare Provider Details

I. General information

NPI: 1679622641
Provider Name (Legal Business Name): MICHIGAN COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5239 MORRISH RD
SWARTZ CREEK MI
48473-7645
US

IV. Provider business mailing address

PO BOX 317
SWARTZ CREEK MI
48473-0317
US

V. Phone/Fax

Practice location:
  • Phone: 810-635-4407
  • Fax: 810-635-4086
Mailing address:
  • Phone: 810-635-4407
  • Fax: 810-635-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG KIRKLAND
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 810-635-4407