Provider Demographics
NPI:1851590855
Name:COMMUNITY AIDS RESOURCE AND EDUCATION SERVICES OF SOUTHWEST MICHIGAN
Entity Type:Organization
Organization Name:COMMUNITY AIDS RESOURCE AND EDUCATION SERVICES OF SOUTHWEST MICHIGAN
Other - Org Name:PIONEER WELLNESS NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-381-2437
Mailing Address - Street 1:629 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1860
Mailing Address - Country:US
Mailing Address - Phone:269-381-2437
Mailing Address - Fax:269-381-4050
Practice Address - Street 1:629 PIONEER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1860
Practice Address - Country:US
Practice Address - Phone:269-381-2437
Practice Address - Fax:269-381-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty