Provider Demographics
NPI:1154744597
Name:HOLY FAMILY HEALTHCARE
Entity type:Organization
Organization Name:HOLY FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-279-9332
Mailing Address - Street 1:301 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-1199
Mailing Address - Country:US
Mailing Address - Phone:269-621-0011
Mailing Address - Fax:
Practice Address - Street 1:301 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-1199
Practice Address - Country:US
Practice Address - Phone:269-621-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010949341041C0700X, 261QM0855X
176B00000X, 207Q00000X, 251B00000X, 261QM1300X
MI5101011443208000000X
MI5601002054363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty