Provider Demographics
NPI:1336467729
Name:COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN
Entity Type:Organization
Organization Name:COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERMESIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-772-5930
Mailing Address - Street 1:301 S CRAPO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2941
Mailing Address - Country:US
Mailing Address - Phone:989-773-6961
Mailing Address - Fax:
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-773-6961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2018-11-30
Deactivation Date:2018-11-23
Deactivation Code:
Reactivation Date:2018-11-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI774352754Medicaid
MI214344340Medicaid