MEDICARE: CALHOUN SPECIALIZED CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	AS130294928	MI
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	AS130286956	MI
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	AS130268236	MI

General Provider Information

NPI Number	:	1831405018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALHOUN SPECIALIZED CARE

Provider Business Mailing Address
First Line	:	PO BOX 175
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49016-0175
Country	:	US
Telephone Number	:	269-317-9508
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 N UNION ST
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-4744
Country	:	US
Telephone Number	:	269-317-9508
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	RONDA RAE WATES
Credential	:
Telephone Number	:	269-317-9508

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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