Organization Name: | BLUES BUSTERS |
NPI Number: | 1275914707 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANNA-MAGDALENA L CHRISTIANSON (CEO) |
Mailing Address: | 9572 Red Bud Trl Berrien Springs |
State: | MI US |
Postal Code: | 491039517 |
Phone Number: | 2692086125 |
Fax Number: | 2695936012 |
NPI Enumeration Date: | 06/10/2015 |
NPI Last Update Date: | 06/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |