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404 Velvet Ave Portage MI 49002-7050 | |
| (269) 491-5647 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 404 Velvet Ave, Portage, Michigan |
| Authorized Official Name and Position | Gloria Jackson Carr (RN) |
| Authorized Official Contact | 2694915647 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
404 Velvet Ave Portage MI 49002-7050 Ph: (269) 491-5647 | 404 Velvet Ave Portage MI 49002-7050 Ph: (269) 491-5647 |
| NPI Number | 1548426372 |
|---|---|
| Provider Enumeration Date | 07/31/2008 |
| Last Update Date | 07/31/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548426372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 4704200513 (Michigan) | Primary |
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