Provider Demographics
NPI:1952557621
Name:FAMILY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER, INC
Other - Org Name:FAMILY HEALTH CENTER PHARMACY-SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-349-2641
Mailing Address - Street 1:2918 PORTAGE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-3755
Mailing Address - Country:US
Mailing Address - Phone:269-488-8516
Mailing Address - Fax:269-488-8530
Practice Address - Street 1:2918 PORTAGE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3755
Practice Address - Country:US
Practice Address - Phone:269-488-8516
Practice Address - Fax:269-488-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010088943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116567OtherPK