Provider Demographics
NPI:1801119466
Name:ALLEGAN COUNTY COMMUNITY MENTAL HEALTH
Entity type:Organization
Organization Name:ALLEGAN COUNTY COMMUNITY MENTAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-673-6617
Mailing Address - Street 1:3283 122ND AVE
Mailing Address - Street 2:PO DRAWER 130
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9511
Mailing Address - Country:US
Mailing Address - Phone:269-673-6617
Mailing Address - Fax:269-686-4601
Practice Address - Street 1:3283 122ND AVE
Practice Address - Street 2:PO DRAWER 130
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:269-673-6617
Practice Address - Fax:269-686-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI774352861Medicaid