Provider Demographics
NPI:1275377194
Name:MOUNT HEALTH SERVICES LLC
Entity type:Organization
Organization Name:MOUNT HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HATUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-900-8654
Mailing Address - Street 1:3654 BRAMBLEBERRY DR NW
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9796
Mailing Address - Country:US
Mailing Address - Phone:231-408-9654
Mailing Address - Fax:
Practice Address - Street 1:3654 BRAMBLEBERRY DR NW
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-9796
Practice Address - Country:US
Practice Address - Phone:231-408-9654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty