HACKLEY COMMUNITY CARE CENTER INC (NPI# 1508245408) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508245408 |
| Entity Type | Organization |
| Organization Name | HACKLEY COMMUNITY CARE CENTER INC |
| Practice Address |
80 W Southern Ave Muskegon MI 49441-2541 |
| Mailing Address |
2700 Baker St Fl 3 Muskegon MI 49444-2157 |
| Practice Telephone | 2317336680 |
| Mailing Telephone | 2317371335 |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2018-02-13 |
| Authorized Official Name | WAYNE KOHN (CMO) |
| Authorized Official Telephone | 2317371335 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | NPI | 1508245408 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658244 | Hackley Community Care Center Inc | Clinic/Center | 3113 Pontaluna Rd Ste A, Fruitport, MI 49415-9600 | 2020-10-30 |
| 1760080972 | Hackley Community Care Center Inc | Clinic/Center | 1420 Madison St Ste A, Muskegon, MI 49442-5251 | 2020-10-12 |
| 1922613975 | Hackley Community Care Center Inc | Clinic/Center | 6245 Syers Rd Ste A, Holton, MI 49425-7557 | 2020-09-15 |
| 1598319915 | Hackley Community Care Center Inc | Clinic/Center | 2312 Denmark St, Muskegon, MI 49441-1479 | 2019-07-25 |
| 1619485398 | Hackley Community Care Center Inc | Family Medicine | 481 S Wolf Lake Rd Ste A, Muskegon, MI 49442-3033 | 2018-01-17 |
| 1962881862 | Hackley Community Care Center Inc | Counselor | 1150 Amity Ave, Muskegon, MI 49442-3713 | 2015-05-26 |
| 1881073781 | Hackley Community Care Center Inc | Counselor | 480 Bennett St, Muskegon, MI 49442-2133 | 2015-05-26 |
| 1699154591 | Hackley Community Care Center Inc | Counselor | 2441 Sanford St, Muskegon, MI 49444-1438 | 2015-05-26 |
| 1063891968 | Hackley Community Care Center Inc | Counselor | 125 Catherine Ave, Muskegon, MI 49442-3331 | 2015-05-26 |
| 1699154500 | Hackley Community Care Center Inc | Counselor | 251 S Wolf Lake Rd, Muskegon, MI 49442-3029 | 2015-05-26 |
| Street Address |
80 W SOUTHERN AVE |
| City | MUSKEGON |
| State | MI |
| Zip Code | 49441-2541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821591413 | Tyrell E Tolliver | Specialist/Technologist | 80 W Southern Ave, Muskegon, MI 49441-2541 | 2018-03-09 |
| 1780057562 | Lindsey Hoffman | Dental Hygienist | 80 W Southern Ave, Muskegon, MI 49441-2541 | 2015-11-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720692494 | Memphis Chardell Sandoval | Nurse Practitioner | 131 S. Seaway Dr., Muskegon, MI 49441 | 2020-09-01 |
| 1598222952 | Kimberlee K Erickson-worpel Ma,llp | Psychologist | 3611 Henry Street, Norton Shores, MI 49441 | 2019-02-21 |
| 1164921011 | Brittany Ann Bayne | Behavior Technician | 640 Seminole, Muskegon, MI 49441 | 2018-02-06 |
| 1497273403 | Rx Optical Laboratories, Inc. | Optometrist | 3445 Henry St, Norton Shores, MI 49441 | 2017-08-30 |
| 1801320072 | Gentle Souls Home Care, LLC | In Home Supportive Care | 2743 Henry Street Pmb #117, Muskegon, MI 49441 | 2017-04-14 |
| 1467814889 | Lyle Karp | Hearing Instrument Specialist | 3145 Henry St., Muskegon, MI 49441 | 2016-03-24 |
| 1649653817 | Jessica Marie Lambert | Dentist | 5978 Harvey St., Muskegon, MI 49441 | 2015-07-06 |
| 1114320595 | Mark Reider | Counselor | 3944 Grand Haven Rd Apt 204c, Norton Shores, MI 49441 | 2014-09-30 |
| 1679826002 | Kathleen M Dole | Social Worker | 800 E Ellis Rd Ste 222, Norton Shores, MI 49441 | 2012-10-23 |
| 1144523119 | Terri Lee Garza | Social Worker | 1095 Third St, Muskegon, MI 49441 | 2010-12-14 |
| Find all providers in zip 49441 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760080972 | Hackley Community Care Center Inc | Clinic/Center | 1420 Madison St Ste A, Muskegon, MI 49442-5251 | 2020-10-12 |
| 1598319915 | Hackley Community Care Center Inc | Clinic/Center | 2312 Denmark St, Muskegon, MI 49441-1479 | 2019-07-25 |
| 1255331583 | Mgh Family Health Center | Clinic/Center | 2201 S Getty St, Muskegon, MI 49444-1207 | 2005-07-28 |
| 1912506635 | Hackley Community Care Center Inc | Clinic/Center | 2700 Baker St Fl 3, Muskegon, MI 49444-2157 | 2020-10-23 |
| 1194379172 | Hackley Community Care Center Inc | Clinic/Center | 35 S Sheridan Dr, Muskegon, MI 49442-1440 | 2019-07-29 |
| 1346600905 | Cherry Street Services Inc | Clinic/Center | 1611 Oak Ave, Muskegon, MI 49442-2468 | 2016-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658244 | Hackley Community Care Center Inc | Clinic/Center | 3113 Pontaluna Rd Ste A, Fruitport, MI 49415-9600 | 2020-10-30 |
| 1831706993 | Family Medical Center of Michigan, Inc | Clinic/Center | 503 Washington St Rm 150, Monroe, MI 48161-1309 | 2020-09-23 |
| 1326654666 | Family Medical Center of Michigan,inc | Clinic/Center | 550 E Main St Ste 1001, Hudson, MI 49247-9535 | 2020-09-22 |
| 1922613975 | Hackley Community Care Center Inc | Clinic/Center | 6245 Syers Rd Ste A, Holton, MI 49425-7557 | 2020-09-15 |
| 1700400389 | Northwest Michigan Health Services, Inc. | Clinic/Center | 300 W Broadway Ave Trlr 1, Scottville, MI 49454-1019 | 2020-05-30 |
| 1679195721 | Family Medical Center of Michigan,inc | Clinic/Center | 2740 Collingwood St Ste 100, Detroit, MI 48206-1473 | 2020-05-12 |
| 1235750571 | Great Lakes Bay Health Centers | Clinic/Center | 2300 Veterans Memorial Pkwy, Saginaw, MI 48601-1268 | 2020-04-28 |
| 1053948265 | Upper Great Lakes Family Health Center | Clinic/Center | 1414 W Fair Ave Ste 242, Marquette, MI 49855-5406 | 2020-03-26 |
| 1568096923 | Grace Health, Inc. | Clinic/Center | 825 Capital Ave Ne, Battle Creek, MI 49017-5605 | 2020-02-25 |
| 1336779131 | Northwest Michigan Health Services Inc. | Clinic/Center | 512 Bryant Ave., Room 23, Manistee, MI 49660-1839 | 2020-01-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.