Provider Demographics
NPI:1477143840
Name:MUSKEGON RIVER YOUTH HOME, INC.
Entity Type:Organization
Organization Name:MUSKEGON RIVER YOUTH HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-587-8880
Mailing Address - Street 1:12775 HORSEFERRY RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7265
Mailing Address - Country:US
Mailing Address - Phone:317-587-8880
Mailing Address - Fax:
Practice Address - Street 1:3030 LONG LN
Practice Address - Street 2:
Practice Address - City:EVART
Practice Address - State:MI
Practice Address - Zip Code:49631-7218
Practice Address - Country:US
Practice Address - Phone:231-734-6254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children