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General NPI Number Information
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NPI Number | 1477815645
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Entity Type | Organization
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Legal Business Name | KALAMAZOO COMMUNITY MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 3299 GULL RD W1F4
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City | KALAMAZOO
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State | MI
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Zip | 49048
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Country | US
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Telephone | 269-553-8000
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Fax | 269-553-8012
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Provider Business Mailing Address
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Address Line | 3299 GULL RD PO BOX63, W1F4
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City | KALAMAZOO
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State | MI
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Zip | 49048-1281
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Country | US
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Telephone | 269-553-8000
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Fax | 269-553-8012
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Authorized Official
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Title or Position | IT DIRECTOR
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Name | EDWARD R SOVA JR.
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Credential |
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Telephone | 269-553-8000
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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 | 390177
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License Number State | MI
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