Provider Demographics
NPI:1275644775
Name:TUSCOLA COUNTY COMMUNITY MENTAL HEALTH SERVICES BOARD
Entity Type:Organization
Organization Name:TUSCOLA COUNTY COMMUNITY MENTAL HEALTH SERVICES BOARD
Other - Org Name:TUSCOLA BEHAVIORAL HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-673-6191
Mailing Address - Street 1:323 N STATE ST
Mailing Address - Street 2:PO BOX 239
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1537
Mailing Address - Country:US
Mailing Address - Phone:989-673-6191
Mailing Address - Fax:989-673-1596
Practice Address - Street 1:323 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1537
Practice Address - Country:US
Practice Address - Phone:989-673-6191
Practice Address - Fax:989-673-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B66002Medicare PIN
MI0M29340Medicare PIN