Provider Demographics
NPI:1205216371
Name:WHALEY CHILDREN'S CENTER
Entity Type:Organization
Organization Name:WHALEY CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:810-234-3603
Mailing Address - Street 1:1201 N GRAND TRAVERSE ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1312
Mailing Address - Country:US
Mailing Address - Phone:810-234-3603
Mailing Address - Fax:810-232-3416
Practice Address - Street 1:1201 N GRAND TRAVERSE ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1312
Practice Address - Country:US
Practice Address - Phone:810-234-3603
Practice Address - Fax:810-232-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICI250201313253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency