Provider Demographics
NPI:1225185721
Name:CENTRAL DIAGNOSTIC & REFERRAL SERVICE
Entity Type:Organization
Organization Name:CENTRAL DIAGNOSTIC & REFERRAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDENACH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:517-337-7209
Mailing Address - Street 1:2875 NORTHWIND DR STE 230
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5085
Mailing Address - Country:US
Mailing Address - Phone:517-337-7209
Mailing Address - Fax:
Practice Address - Street 1:2875 NORTHWIND DR STE 230
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5085
Practice Address - Country:US
Practice Address - Phone:517-337-7209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI330143251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health