Provider Demographics
NPI:1265177521
Name:REDBURN, CHARLES JAMES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JAMES
Last Name:REDBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1205
Mailing Address - Country:US
Mailing Address - Phone:989-860-4005
Mailing Address - Fax:
Practice Address - Street 1:1525 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-6425
Practice Address - Country:US
Practice Address - Phone:989-835-6333
Practice Address - Fax:989-835-4920
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician