Provider Demographics
NPI:1215016449
Name:OTTAWA COUNTY CMH
Entity Type:Organization
Organization Name:OTTAWA COUNTY CMH
Other - Org Name:BCBS 785 W. RANDALL
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CYRANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-393-5649
Mailing Address - Street 1:12265 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8613
Mailing Address - Country:US
Mailing Address - Phone:616-393-5641
Mailing Address - Fax:616-393-5687
Practice Address - Street 1:785 W RANDALL ST
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1307
Practice Address - Country:US
Practice Address - Phone:616-837-8171
Practice Address - Fax:616-837-5823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health