Provider Demographics
NPI:1851591309
Name:CLINTON COUNTY FAMILY RESOURCE CENTER
Entity Type:Organization
Organization Name:CLINTON COUNTY FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREVENTION SERVICES COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RNBA
Authorized Official - Phone:989-224-1173
Mailing Address - Street 1:4179 S US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-9110
Mailing Address - Country:US
Mailing Address - Phone:989-224-0598
Mailing Address - Fax:
Practice Address - Street 1:4179 S US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-9110
Practice Address - Country:US
Practice Address - Phone:989-224-0598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4228851251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4228851Medicaid