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General NPI Number Information
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NPI Number | 1922267376
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Entity Type | Organization
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Legal Business Name | BASELINE CLINICAL SERVICE
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 43 30TH ST
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City | ALLEGAN
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State | MI
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Zip | 49010-9740
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Country | US
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Telephone | 269-673-8525
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Fax |
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Provider Business Mailing Address
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Address Line | 38175 32ND ST
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City | PAW PAW
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State | MI
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Zip | 49079-8444
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Country | US
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Telephone | 269-673-8525
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID C. FERRY
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Credential | L.L.P.
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Telephone | 269-673-8525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS030258948
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License Number State | MI
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