Organization
HACKLEY COMMUNITY CARE CENTER INC
Active
Organization
HACKLEY COMMUNITY CARE CENTER INC
Active
Other names
Holton High School
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE KOESTNER DO (CMO)
(231) 737-1335
Entity
Organization
Contact information
Practice address
6477 SYERS RD, HOLTON, MI 49425-7508
(231) 733-6820
Mailing address
2700 BAKER ST FL 3, 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
07/26/2019
Last updated
07/26/2019
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