Provider Demographics
NPI:1659485514
Name:HURON COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type:Organization
Organization Name:HURON COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Other - Org Name:HURON BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-269-1129
Mailing Address - Street 1:1375 R DALE WERTZ DR
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1365
Mailing Address - Country:US
Mailing Address - Phone:989-269-9293
Mailing Address - Fax:989-269-7544
Practice Address - Street 1:1375 R DALE WERTZ DR
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1365
Practice Address - Country:US
Practice Address - Phone:989-269-9293
Practice Address - Fax:989-269-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-02-13
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
MI7509109570OtherBCBS
MI774352852Medicaid
MI0C26010Medicare ID - Type UnspecifiedPHYSICIAN GROUP