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General NPI Number Information
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NPI Number | 1205902103
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Entity Type | Organization
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Legal Business Name | ELLA E. M. BROWN CHARITABLE CIRCLE
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 310 MICHIGAN AVE
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City | MARSHALL
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State | MI
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Zip | 49068-1665
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Country | US
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Telephone | 269-789-3921
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Fax | 269-781-7117
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Provider Business Mailing Address
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Address Line | 200 N MADISON ST
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City | MARSHALL
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State | MI
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Zip | 49068-1143
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Country | US
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Telephone | 269-789-3921
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Fax | 269-781-7117
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MS. COLLEEN M. KOPPENHAVER
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Credential |
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Telephone | 269-789-3921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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