Provider Demographics
NPI:1003878554
Name:VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type:Organization
Organization Name:VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:269-657-5574
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:801 HAZEN ST STE C
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0249
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:269-657-3474
Practice Address - Street 1:801 HAZEN ST
Practice Address - Street 2:STE C
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-0249
Practice Address - Country:US
Practice Address - Phone:269-657-5574
Practice Address - Fax:269-657-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H04645Medicare PIN
MI0H06340Medicare PIN
MI0H06346Medicare PIN