Provider Demographics
NPI:1922498393
Name:KALAMAZOO PROBATION ENHANCEMENT PROGRAM
Entity Type:Organization
Organization Name:KALAMAZOO PROBATION ENHANCEMENT PROGRAM
Other - Org Name:KPEP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-903-0510
Mailing Address - Street 1:519 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5117
Mailing Address - Country:US
Mailing Address - Phone:269-383-0450
Mailing Address - Fax:269-383-2066
Practice Address - Street 1:519 S PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5117
Practice Address - Country:US
Practice Address - Phone:269-383-0450
Practice Address - Fax:269-383-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390145101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty