| Sed Waiver | |
|
3111 Electric Ave Port Huron MI 48060-8127 | |
| (810) 985-8900 | |
| (810) 985-7620 |
| Full Name | Sed Waiver |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3111 Electric Ave, Port Huron, Michigan |
| Authorized Official Name and Position | Debra B Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8109667886 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sed Waiver 3111 Electric Ave Port Huron MI 48060 Ph: (810) 985-8900 | Sed Waiver 3111 Electric Ave Port Huron MI 48060-8127 Ph: (810) 985-8900 |
| NPI Number | 1295083723 |
|---|---|
| Provider Enumeration Date | 08/15/2012 |
| Last Update Date | 08/07/2023 |
| Certification Date | 08/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295083723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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