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General NPI Number Information
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NPI Number | 1477143840
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Entity Type | Organization
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Legal Business Name | MUSKEGON RIVER YOUTH HOME, INC.
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 3030 LONG LN
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City | EVART
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State | MI
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Zip | 49631-7218
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Country | US
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Telephone | 231-734-6254
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Fax |
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Provider Business Mailing Address
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Address Line | 12775 HORSEFERRY RD STE 230
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City | CARMEL
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State | IN
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Zip | 46032-7265
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Country | US
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Telephone | 317-587-8880
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RONALD D HUNTER
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Credential |
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Telephone | 317-587-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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