Provider Demographics
NPI:1932472891
Name:MIDLAND COUNTY JUVENILE CARE CENTER
Entity Type:Organization
Organization Name:MIDLAND COUNTY JUVENILE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-837-6080
Mailing Address - Street 1:3712 E ASHMAN RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-9314
Mailing Address - Country:US
Mailing Address - Phone:989-837-6080
Mailing Address - Fax:989-837-6094
Practice Address - Street 1:3712 E ASHMAN RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-9314
Practice Address - Country:US
Practice Address - Phone:989-837-6080
Practice Address - Fax:989-837-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICO560201303251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health