Organization
HACKLEY COMMUNITY CARE CENTER INC
Active
Other names
Muskegon Covenant Academy
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE KOHN DO (CMO)
(231) 737-1335
Entity
Organization
Contact information
Practice address
125 CATHERINE AVE, MUSKEGON, MI 49442-3331
(231) 733-6703
Mailing address
2700 BAKER ST FL 3, MUSKEGON, MI 49444-2157
(231) 737-1335
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063891968
NPI
MI
Enumeration date
05/26/2015
Last updated
06/30/2015
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