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General NPI Number Information
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NPI Number | 1902717994
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Entity Type | Organization
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Legal Business Name | HICKORY HOLLOW II SPECIALIZED RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 6485 HICKORY HOLLOW CT
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City | FLINT
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State | MI
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Zip | 48532-2055
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Country | US
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Telephone | 833-478-9464
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Fax |
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Provider Business Mailing Address
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Address Line | 3060 S DYE RD
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City | FLINT
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State | MI
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Zip | 48507-1078
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Country | US
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Telephone | 833-478-9464
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Fax |
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Authorized Official
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Title or Position | LICENSEE/DESIGNEE
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Name | CHRISTINE BERTRAM
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Credential |
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Telephone | 833-478-9464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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