Provider Demographics
NPI:1932309945
Name:VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, SUBSTANCE ABUSE SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:FATZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:269-621-3143
Mailing Address - Street 1:801 HAZEN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-2008
Mailing Address - Country:US
Mailing Address - Phone:269-657-5596
Mailing Address - Fax:269-657-5866
Practice Address - Street 1:57418 COUNTY ROAD 681
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-9421
Practice Address - Country:US
Practice Address - Phone:269-621-3143
Practice Address - Fax:269-621-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI800028251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health