Provider Demographics
NPI:1154032498
Name:JACKSON-HILLSDALE COMMUNITY MENTAL HEALTH BOARD
Entity type:Organization
Organization Name:JACKSON-HILLSDALE COMMUNITY MENTAL HEALTH BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIBETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-789-1209
Mailing Address - Street 1:ROBIN MILLER
Mailing Address - Street 2:1200 W. AVENUE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202
Mailing Address - Country:US
Mailing Address - Phone:517-789-2481
Mailing Address - Fax:
Practice Address - Street 1:ROBIN MILLER
Practice Address - Street 2:1200 W. AVENUE
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-789-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility