Provider Demographics
NPI:1952858987
Name:FAMILY HEALTH & WELLNESS PC
Entity Type:Organization
Organization Name:FAMILY HEALTH & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:PH-C
Authorized Official - Phone:989-435-2937
Mailing Address - Street 1:129 W BROWN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:MI
Mailing Address - Zip Code:48612-8119
Mailing Address - Country:US
Mailing Address - Phone:989-435-2937
Mailing Address - Fax:989-435-3121
Practice Address - Street 1:129 W BROWN ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:MI
Practice Address - Zip Code:48612-8119
Practice Address - Country:US
Practice Address - Phone:989-435-2937
Practice Address - Fax:989-435-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004029261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1952858987Medicaid