Provider Demographics
NPI:1710074448
Name:MONTCALM CARE NETWORK
Entity Type:Organization
Organization Name:MONTCALM CARE NETWORK
Other - Org Name:THE MONTCALM CENTER FOR BEHAVIORAL HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSOCIATE DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-831-7577
Mailing Address - Street 1:611 N STATE STREET
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48888
Mailing Address - Country:US
Mailing Address - Phone:989-831-7520
Mailing Address - Fax:989-831-7578
Practice Address - Street 1:611 N STATE STREET
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888
Practice Address - Country:US
Practice Address - Phone:989-831-7520
Practice Address - Fax:989-831-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712461Medicaid
MI1712461Medicaid
OE96019Medicare ID - Type Unspecified