Organization
BANGOR HEALTH CENTER
Active
Parent organization
VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
VAN BUREN COMMUNITY MENTAL HEALTH AUTHORITY
Authorized official
MRS. DEBRA L.R. HESS (CHIEF EXECUTIVE OFFICER)
(269) 567-5574
Entity
Organization
Contact information
Practice address
803 WEST ARLINGTON STREET, BANGOR, MI 49013-1108
(269) 427-6810
Mailing address
PO BOX 249, 801 HAZEN STREET, SUITE C., PAW PAW, MI 49079-0249
(269) 657-5574
(269) 657-3474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50-0-H01075-0
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
12/17/2008
Last updated
05/07/2009
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