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General NPI Number Information
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NPI Number | 1932472891
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Entity Type | Organization
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Legal Business Name | MIDLAND COUNTY JUVENILE CARE CENTER
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 3712 E ASHMAN RD
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City | MIDLAND
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State | MI
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Zip | 48642-9314
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Country | US
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Telephone | 989-837-6080
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Fax | 989-837-6094
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Provider Business Mailing Address
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Address Line | 3712 E ASHMAN RD
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City | MIDLAND
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State | MI
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Zip | 48642-9314
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Country | US
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Telephone | 989-837-6080
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Fax | 989-837-6094
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MARK BUTCHER
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Credential |
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Telephone | 989-837-6080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CO560201303
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License Number State | MI
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