| Logan Community Resources, Inc. | |
|
1651 E Nickerson Ave Benton Harbor MI 49022-2469 | |
| (269) 983-5833 | |
| (269) 363-4630 |
| Full Name | Logan Community Resources, Inc. |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1651 E Nickerson Ave, Benton Harbor, Michigan |
| Authorized Official Name and Position | Maria Fernandez (MANAGER OF REVENUE CYCLE) |
| Authorized Official Contact | 6265312992 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Community Resources, Inc. 1651 E Nickerson Ave Benton Harbor MI 49022-2469 Ph: (269) 983-5833 | Logan Community Resources, Inc. 1651 E Nickerson Ave Benton Harbor MI 49022-2469 Ph: (269) 983-5833 |
| NPI Number | 1861071789 |
|---|---|
| Provider Enumeration Date | 04/07/2021 |
| Last Update Date | 04/13/2021 |
| Certification Date | 04/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861071789 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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