Provider Demographics
NPI:1922267376
Name:BASELINE CLINICAL SERVICE
Entity Type:Organization
Organization Name:BASELINE CLINICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:269-673-8525
Mailing Address - Street 1:38175 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-8444
Mailing Address - Country:US
Mailing Address - Phone:269-673-8525
Mailing Address - Fax:
Practice Address - Street 1:43 30TH ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9740
Practice Address - Country:US
Practice Address - Phone:269-673-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS030258948320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness