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General NPI Number Information
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NPI Number | 1215016449
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Entity Type | Organization
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Legal Business Name | OTTAWA COUNTY CMH
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 785 W RANDALL ST
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City | COOPERSVILLE
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State | MI
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Zip | 49404-1307
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Country | US
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Telephone | 616-837-8171
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Fax | 616-837-5823
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Provider Business Mailing Address
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Address Line | 12265 JAMES ST
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City | HOLLAND
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State | MI
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Zip | 49424-8613
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Country | US
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Telephone | 616-393-5641
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Fax | 616-393-5687
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GERARD CYRANOWSKI
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Credential |
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Telephone | 616-393-5649
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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 |
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License Number State |
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