| Western Michigan Treatment Center | |
|
3584 Fairlanes Ave Sw Ste 2 Grandville MI 49418-1583 | |
| (855) 380-8272 | |
| Not Available |
| Full Name | Western Michigan Treatment Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 3584 Fairlanes Ave Sw, Grandville, Michigan |
| Authorized Official Name and Position | Brian Phillip Farley (VP & SECRETARY) |
| Authorized Official Contact | 6158616000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Michigan Treatment Center 6183 Paseo Del Norte Suite 200 Carlsbad CA 92011-1155 Ph: (855) 259-2288 | Western Michigan Treatment Center 3584 Fairlanes Ave Sw Ste 2 Grandville MI 49418-1583 Ph: (855) 380-8272 |
| NPI Number | 1942670559 |
|---|---|
| Provider Enumeration Date | 09/25/2015 |
| Last Update Date | 08/14/2023 |
| Certification Date | 08/14/2023 |
| Medicare PECOS PAC ID | 0345507042 |
|---|---|
| Medicare Enrollment ID | O20171206000164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942670559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 261QM2800X | Clinic/center - Methadone | (* (Not Available)) | Primary |
| Provider Name | Julie M Wilson |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1093934267 PECOS PAC ID: 0143326579 Enrollment ID: I20070502000047 |
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