Organization
INTERCARE COMMUNITY HEALTH NETWORK DENTAL VAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VELMA HENDERSHOTT (CEO/PRESIDENT)
(269) 427-7937
Entity
Organization
Contact information
Practice address
308 CHARLES STREET, BANGOR, MI 49013-1246
(269) 427-7937
(269) 427-5180
Mailing address
50 INDUSTRIAL PARK RD, BANGOR, MI 49013-1246
(269) 427-7937
(269) 427-5180
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/28/2014
Last updated
07/28/2014
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