Provider Demographics
NPI:1528526266
Name:MID-MICHIGAN RECOVERY CENTER
Entity type:Organization
Organization Name:MID-MICHIGAN RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-418-1489
Mailing Address - Street 1:3821 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-9606
Mailing Address - Country:US
Mailing Address - Phone:989-418-1489
Mailing Address - Fax:
Practice Address - Street 1:3821 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-9606
Practice Address - Country:US
Practice Address - Phone:989-418-1489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility