Organization
HACKLEY COMMUNITY CARE CENTER INC
Active
Other names
Bunker Elementary School
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE KINGSLEY DO (CMO)
(231) 737-1335
Entity
Organization
Contact information
Practice address
2312 DENMARK ST, MUSKEGON, MI 49441-1479
(231) 733-6760
Mailing address
2700 BAKER ST, MUSKEGON, MI 49444-2157
(231) 737-1335
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629066238
—
MI
Enumeration date
07/25/2019
Last updated
10/01/2020
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