Organization
INTERCARE COMMUNITY HEALTH NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VELMA HENDERSHOTT (CEO/PRESIDENT)
(269) 427-7937
Entity
Organization
Contact information
Practice address
5498 109TH AVE, PULLMAN, MI 49450-9631
(855) 869-6900
(269) 236-0505
Mailing address
50 INDUSTRIAL PARK RD, BANGOR, MI 49013-1246
(269) 427-7937
(269) 427-5180
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
11/16/2017
Last updated
11/16/2017
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