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General NPI Number Information
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NPI Number | 1396965364
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Entity Type | Organization
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Legal Business Name | COMMUNITY SUBSTANCE ABUSE SERVICES, INC.
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 373 WOODWARD AVE
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City | KINGSFORD
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State | MI
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Zip | 49802-4628
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Country | US
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Telephone | 906-774-7511
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Fax | 906-774-7357
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Provider Business Mailing Address
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Address Line | 373 WOODWARD AVE
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City | KINGSFORD
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State | MI
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Zip | 49802-4628
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Country | US
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Telephone | 906-774-7511
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Fax | 906-774-7357
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Authorized Official
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Title or Position | CEO
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Name | MS. MYRA J BROOKS
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Credential |
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Telephone | 906-774-7511
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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 | 220003
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License Number State | MI
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