Provider Demographics
NPI:1972817351
Name:THE FOWLER CENTER
Entity Type:Organization
Organization Name:THE FOWLER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:313-418-8385
Mailing Address - Street 1:2315 HARMON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48744-9737
Mailing Address - Country:US
Mailing Address - Phone:989-673-2050
Mailing Address - Fax:989-673-6355
Practice Address - Street 1:2315 HARMON LAKE RD
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:MI
Practice Address - Zip Code:48744-9737
Practice Address - Country:US
Practice Address - Phone:989-673-2050
Practice Address - Fax:989-673-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAC790200832385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp