Organization
HACKLEY COMMUNITY CARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE KOHN DO (MEDICAL DIRECTOR)
(231) 737-1335
Entity
Organization
Contact information
Practice address
2700 BAKER ST FL 3, MUSKEGON, MI 49444-2157
(231) 737-1335
(231) 737-0534
Mailing address
2700 BAKER ST FL 3, MUSKEGON, MI 49444-2157
(231) 737-1335
(231) 737-0534
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629066238
GROUP NPI
MI
Enumeration date
11/19/2009
Last updated
06/09/2011
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