Provider Demographics
NPI:1477225506
Name:KALAMAZOO COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity type:Organization
Organization Name:KALAMAZOO COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-553-8027
Mailing Address - Street 1:2030 PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-3836
Mailing Address - Country:US
Mailing Address - Phone:269-553-8018
Mailing Address - Fax:269-553-8012
Practice Address - Street 1:615 E CROSSTOWN PKWY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2501
Practice Address - Country:US
Practice Address - Phone:269-373-6000
Practice Address - Fax:269-373-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)