Provider Demographics
NPI:1851824809
Name:MCCULLOUGH VARGAS ASSOCIATES
Entity Type:Organization
Organization Name:MCCULLOUGH VARGAS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:517-264-2244
Mailing Address - Street 1:110 READING AVE
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1136
Mailing Address - Country:US
Mailing Address - Phone:517-849-2330
Mailing Address - Fax:
Practice Address - Street 1:110 READING AVE
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1136
Practice Address - Country:US
Practice Address - Phone:517-849-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0300027324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility