Provider Demographics
NPI:1235115460
Name:COUNTY OF GENESEE OFFICE OF CONTROLLER
Entity Type:Organization
Organization Name:COUNTY OF GENESEE OFFICE OF CONTROLLER
Other - Org Name:GENESEE COUNTY COMMUNITY MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-257-3707
Mailing Address - Street 1:420 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-257-3736
Mailing Address - Fax:810-257-3785
Practice Address - Street 1:420 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-257-3736
Practice Address - Fax:810-257-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIME01009742083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2747864Medicaid
MI2125345Medicaid
MI4166893Medicaid
MI4279879Medicaid
MI3283410Medicaid
MI4643653Medicaid
MI4422456Medicaid
MI5101679Medicaid
MI4691230Medicaid
MI4611319Medicaid