NPIMap

Organization Active NPI

Hackley Community Care Center Inc

Doing business as Muskegon Covenant Academy

  • Federally Qualified Health Center (FQHC)
  • Muskegon, MI
National Provider Identifier
1063891968
Registry record updated Jun 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HACKLEY COMMUNITY CARE CENTER INC
Doing business as
Muskegon Covenant Academy
Practice address
125 Catherine Ave
Muskegon, MI 49442-3331
Phone
(231) 733-6703
NPI assigned
May 26, 2015
Last updated
Jun 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wayne Kohn, DONPI 1679545115
Title
Cmo
Phone
(231) 737-1335

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

125 Catherine Ave
Muskegon, MI 49442-3331

Mailing address

2700 Baker St FL 3
Muskegon, MI 49444-2157
Phone (231) 737-1335

Other names 1

  • Muskegon Covenant Academy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063891968. Details of each certification follow.

  • CCN 231054 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 231054

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MUSKEGON COVENANT ACADEMY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 21, 2015
Last certification
Apr 21, 2015
Ownership / control type
For profit – corporation
Facility address
125 Catherine Ave
Muskegon, MI 49442

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1063891968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 BAKER ST FL 3",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494442157",
            "telephone_number": "231-737-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 CATHERINE AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494423331",
            "telephone_number": "231-733-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKLEY COMMUNITY CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-26",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "KOHN",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "231-737-1335",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Muskegon Covenant Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.