| Cj12 Corporation | |
|
11907 Stone Bluff Dr Grand Ledge MI 48837-2435 | |
| (517) 242-8895 | |
| Not Available |
| Full Name | Cj12 Corporation |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 11907 Stone Bluff Dr, Grand Ledge, Michigan |
| Authorized Official Name and Position | Heather Lynn Terhaar (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5172428895 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cj12 Corporation 11907 Stone Bluff Dr Grand Ledge MI 48837-2435 Ph: (517) 242-8895 | Cj12 Corporation 11907 Stone Bluff Dr Grand Ledge MI 48837-2435 Ph: (517) 242-8895 |
| NPI Number | 1649915885 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 05/02/2022 |
| Certification Date | 05/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649915885 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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