=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659375293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASS COUNTY COMMUNITY MENTAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2005
-----------------------------------------------------
Last Update Date | 03/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 M 60 E
-----------------------------------------------------
City | CASSOPOLIS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49031-9339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-445-2451
-----------------------------------------------------
Fax | 269-445-3216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 960 E STATE ST
-----------------------------------------------------
City | CASSOPOLIS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49031-9339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-445-2451
-----------------------------------------------------
Fax | 269-445-3216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOHN RUDDELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-445-2451
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------