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General NPI Number Information
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NPI Number | 1629307822
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Entity Type | Organization
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Legal Business Name | INTERFACE CONSULTATION SERVICES
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 151 EMMETT ST E
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3319
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Country | US
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Telephone | 269-929-1292
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Fax | 269-965-5267
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Provider Business Mailing Address
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Address Line | 151 EMMETT ST E
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3319
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Country | US
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Telephone | 269-929-1292
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Fax | 269-965-5267
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | CRAIG STUART JUDD
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Credential | MA, LLP
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Telephone | 269-929-1292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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