Provider Demographics
NPI:1558136531
Name:COMSTOCK COMMUNITY CENTER
Entity Type:Organization
Organization Name:COMSTOCK COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMORY CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-345-8556
Mailing Address - Street 1:PO BOX 34, 6330 KING HWY
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:978 RIVER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048
Practice Address - Country:US
Practice Address - Phone:269-345-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care