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General NPI Number Information
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NPI Number | 1891221842
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Entity Type | Organization
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Legal Business Name | ALLEGAN COUNTY 4-H CLUBS
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 39000 1ST AVE
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City | BLOOMINGDALE
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State | MI
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Zip | 49026-9743
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Country | US
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Telephone | 269-521-3559
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Fax | 866-324-2797
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Provider Business Mailing Address
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Address Line | 39000 1ST AVE
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City | BLOOMINGDALE
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State | MI
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Zip | 49026-9743
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Country | US
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Telephone | 269-521-3559
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Fax | 866-324-2797
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KEVIN F KELLY
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Credential |
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Telephone | 269-521-3559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number | CR030200347
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License Number State | MI
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