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General NPI Number Information
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NPI Number | 1770904658
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Entity Type | Organization
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Legal Business Name | WMT INC. RECOVERY & HOUSING CENTER
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 1823 COMMERCE ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2608
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Country | US
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Telephone | 231-728-2138
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Fax | 231-728-4771
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Provider Business Mailing Address
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Address Line | 1823 COMMERCE ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2608
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Country | US
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Telephone | 231-728-2138
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Fax | 231-722-4771
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Authorized Official
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Title or Position | CEO
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Name | MR. LOUIS CHURCHWELL
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Credential |
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Telephone | 231-728-2138
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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 | SA0610022
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA0610022
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License Number State | MI
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