| Jace | |
|
2603 W Wackerly St Ste 100 Midland MI 48640-6905 | |
| (989) 631-4092 | |
| (989) 631-4991 |
| Full Name | Jace |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2603 W Wackerly St Ste 100, Midland, Michigan |
| Authorized Official Name and Position | Angela Chandra Cvolk (VICE PRESIDENT) |
| Authorized Official Contact | 9896314092 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jace 2603 W Wackerly St Ste 100 Midland MI 48640-6905 Ph: (989) 631-4092 | Jace 2603 W Wackerly St Ste 100 Midland MI 48640-6905 Ph: (989) 631-4092 |
| NPI Number | 1679723167 |
|---|---|
| Provider Enumeration Date | 09/22/2008 |
| Last Update Date | 05/23/2024 |
| Certification Date | 05/23/2024 |
| Medicare PECOS PAC ID | 4284074253 |
|---|---|
| Medicare Enrollment ID | O20240425000221 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679723167 | NPI | - | NPPES |
| Provider Name | Angela C Volk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346507860 PECOS PAC ID: 5193165165 Enrollment ID: I20240425000311 |
| Provider Name | Olivia Van Der Leij |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134881014 PECOS PAC ID: 9234570516 Enrollment ID: I20240517000798 |
| Provider Name | David Brian Hotopp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629428909 PECOS PAC ID: 1951743335 Enrollment ID: I20240530003000 |
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