Provider Demographics
NPI:1629252895
Name:VAN BUREN CASS DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:VAN BUREN CASS DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:269-621-3143
Mailing Address - Street 1:57418 COUNTY ROAD 681
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-9421
Mailing Address - Country:US
Mailing Address - Phone:269-621-3143
Mailing Address - Fax:
Practice Address - Street 1:803 WEST ARLINGTON
Practice Address - Street 2:BANGOR HEALTH CENTER
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013
Practice Address - Country:US
Practice Address - Phone:269-427-6810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063574251S00000X
MI6301006216251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health