Provider Demographics
NPI:1336341882
Name:COUNTY OF KALAMAZOO
Entity Type:Organization
Organization Name:COUNTY OF KALAMAZOO
Other - Org Name:KALAMAZOO COUNTY HEALTH & COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-373-5261
Mailing Address - Street 1:3299 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1281
Mailing Address - Country:US
Mailing Address - Phone:269-373-5259
Mailing Address - Fax:269-373-5292
Practice Address - Street 1:3299 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1281
Practice Address - Country:US
Practice Address - Phone:269-373-5259
Practice Address - Fax:269-373-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4686786Medicaid