Provider Demographics
NPI:1528166204
Name:CHILDREN'S ASSESSMENT CENTER
Entity type:Organization
Organization Name:CHILDREN'S ASSESSMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMEJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MDMSW
Authorized Official - Phone:616-393-6123
Mailing Address - Street 1:12125 UNION ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8603
Mailing Address - Country:US
Mailing Address - Phone:616-393-6123
Mailing Address - Fax:616-393-0918
Practice Address - Street 1:12125 UNION ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8603
Practice Address - Country:US
Practice Address - Phone:616-393-6123
Practice Address - Fax:616-393-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4574743Medicaid