| |
2329 Center St Boyne Falls MI 49713-9268 | |
(231) 535-2822 | |
(231) 535-2372 |
Full Name | |
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Speciality | Substance Abuse Rehabilitation Facility |
Location | 2329 Center St, Boyne Falls, Michigan |
Authorized Official Name and Position | Jackie Dee Wurst (FINANCIAL DIRECTOR) |
Authorized Official Contact | 2317584566 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2329 Center St Boyne Falls MI 49713-9268 Ph: (231) 535-2822 | 2329 Center St Boyne Falls MI 49713-9268 Ph: (231) 535-2822 |
NPI Number | 1750791505 |
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Provider Enumeration Date | 05/02/2014 |
Last Update Date | 03/25/2024 |
Certification Date | 03/25/2024 |
Medicare PECOS PAC ID | 6901341155 |
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Medicare Enrollment ID | O20240711002303 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750791505 | NPI | - | NPPES |
SA0150024 | Other | MI | LARA LICENSE |
SA0690033 | Other | MI | LARA LICENSE |
SA0240041 | Other | MI | LARA LICENSE |
5801000334 | Other | MI | TRANSPORTATION |
SA0150031 | Other | MI | LARA LICENSE |
Provider Name | Jean Christiana Marion Talsma |
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Provider Type | Practitioner - Addiction Medicine |
Provider Identifiers | NPI Number: 1144660200 PECOS PAC ID: 0840583639 Enrollment ID: I20160802000442 |
Provider Name | Brandon Robert Peter Mielke |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1760004907 PECOS PAC ID: 3375088552 Enrollment ID: I20240711003187 |
Provider Name | Jocindee Gasco |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1235369083 PECOS PAC ID: 0042755225 Enrollment ID: I20240711003427 |
Provider Name | Paul Bennett |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1043069032 PECOS PAC ID: 4183169378 Enrollment ID: I20240711003666 |
Provider Name | Rosaria Vasile |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1902377609 PECOS PAC ID: 1850836057 Enrollment ID: I20240711003867 |
Provider Name | Adam Labarthe |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1770224305 PECOS PAC ID: 2163967365 Enrollment ID: I20240711004034 |
Provider Name | Rebecca Ann Hrzich |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1255925806 PECOS PAC ID: 5294275749 Enrollment ID: I20240911000356 |