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General NPI Number Information
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NPI Number | 1619440658
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Entity Type | Organization
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Legal Business Name | COGIC COMMUNITY CENTER, INC.
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Dates
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Enumeration Date | 01/02/2019
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 2140 VALLEY ST
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City | NORTON SHORES
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State | MI
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Zip | 49444-1261
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Country | US
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Telephone | 231-725-7505
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Fax | 231-722-4609
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Provider Business Mailing Address
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Address Line | 2140 VALLEY ST
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City | NORTON SHORES
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State | MI
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Zip | 49444-1261
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Country | US
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Telephone | 231-725-7505
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Fax | 231-722-4609
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AARON PULSIPHER
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Credential |
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Telephone | 231-725-7505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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