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General NPI Number Information
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NPI Number | 1114207610
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Entity Type | Organization
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Legal Business Name | STRAIGHTWAYS LLC
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 7061 W N AVE
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City | KALAMAZOO
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State | MI
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Zip | 49009-9508
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Country | US
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Telephone | 269-267-6491
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Fax |
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Provider Business Mailing Address
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Address Line | 7061 W N AVE
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City | KALAMAZOO
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State | MI
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Zip | 49009-9508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHIQUITHA CORNELIUS
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Credential |
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Telephone | 269-519-3966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6301014468
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License Number State | MI
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