Provider Demographics
NPI:1891998894
Name:PHC OF MICHIGAN LLC
Entity Type:Organization
Organization Name:PHC OF MICHIGAN LLC
Other - Org Name:DBA HARBOR OAKS OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:6100 TOWER CIR STE 1000
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1509
Mailing Address - Country:US
Mailing Address - Phone:615-861-7566
Mailing Address - Fax:
Practice Address - Street 1:25975 N KNOLLWOOD DR
Practice Address - Street 2:STE D
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2632
Practice Address - Country:US
Practice Address - Phone:586-598-1010
Practice Address - Fax:586-598-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2023-08-22
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
MIBCBSMOther0E01027
MI=========OtherTAX ID
MIBCBSMOther0E01027