Provider Demographics
NPI:1952770893
Name:CENTER FOR HEALING CONNECTIONS LLC
Entity type:Organization
Organization Name:CENTER FOR HEALING CONNECTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNELL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GEMUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:734-344-7432
Mailing Address - Street 1:1645 N DIXIE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-5231
Mailing Address - Country:US
Mailing Address - Phone:734-344-7432
Mailing Address - Fax:734-344-7431
Practice Address - Street 1:1645 N DIXIE HWY STE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5231
Practice Address - Country:US
Practice Address - Phone:734-344-7432
Practice Address - Fax:734-344-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010682561041C0700X
363A00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265805766Medicaid
MI1154005809Medicaid
MI1386392983Medicaid
MI1699301374Medicaid
MI1871162438Medicaid
MI1609381755Medicaid
MI1730810029Medicaid
MI1821535899Medicaid
MI1851909923Medicaid