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1133 S State Rd Ste 5 Davison MI 48423-1963 | |
| (810) 844-1123 | |
| (810) 652-6263 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1133 S State Rd Ste 5, Davison, Michigan |
| Authorized Official Name and Position | Brent Hughes (PRINCIPAL/OWNER) |
| Authorized Official Contact | 8105130707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7083 Stanley Rd Flushing MI 48433-9069 Ph: (810) 513-0707 | 1133 S State Rd Ste 5 Davison MI 48423-1963 Ph: (810) 844-1123 |
| NPI Number | 1710633243 |
|---|---|
| Provider Enumeration Date | 02/23/2022 |
| Last Update Date | 02/02/2025 |
| Certification Date | 02/02/2025 |
| Medicare PECOS PAC ID | 6901252550 |
|---|---|
| Medicare Enrollment ID | O20231102001119 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710633243 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Brent Andrew Hughes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447753215 PECOS PAC ID: 0345503991 Enrollment ID: I20180411002960 |
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