Provider Demographics
NPI:1225740616
Name:CENTRE A MENTAL HEALTH ORGANIZATION LLC
Entity Type:Organization
Organization Name:CENTRE A MENTAL HEALTH ORGANIZATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MICHURA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:616-935-2151
Mailing Address - Street 1:2319 BLOOMFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4472
Mailing Address - Country:US
Mailing Address - Phone:616-633-1767
Mailing Address - Fax:
Practice Address - Street 1:622 E SAVIDGE ST STE 5
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-1957
Practice Address - Country:US
Practice Address - Phone:616-935-2151
Practice Address - Fax:616-469-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802942512OtherLARA