Provider Demographics
NPI:1396790580
Name:PHC OF MICHIGAN, LLC
Entity type:Organization
Organization Name:PHC OF MICHIGAN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:6100 TOWER CIR STE 1000
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1509
Mailing Address - Country:US
Mailing Address - Phone:615-861-6000
Mailing Address - Fax:
Practice Address - Street 1:35031 23 MILE RD
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3649
Practice Address - Country:US
Practice Address - Phone:586-725-5777
Practice Address - Fax:586-725-3095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI001571OtherPSYCH CARE
MI5210664Medicaid
MI115660OtherCARE CHOICES
MIA202377OtherVALUE OPTIONS
MIA853975OtherVALUE OPTIONS OUTPATIENT CLINIC
MI260E010270OtherBCBSM
MI5210646Medicaid
MI5210646Medicaid
MI=========OtherTAX ID