Provider Demographics
NPI:1649561697
Name:COMMUNITY PREVENTION AND TREATMENT SERVICES
Entity type:Organization
Organization Name:COMMUNITY PREVENTION AND TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CAADC
Authorized Official - Phone:517-849-2330
Mailing Address - Street 1:401 W. CHICAGO RD.
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250
Mailing Address - Country:US
Mailing Address - Phone:517-849-2330
Mailing Address - Fax:517-849-2906
Practice Address - Street 1:401 W. CHICAGO RD.
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250
Practice Address - Country:US
Practice Address - Phone:517-849-2330
Practice Address - Fax:517-849-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI300027324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility