Hackley Community Care Center Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

HACKLEY COMMUNITY CARE CENTER INC

Practice address

125 Catherine Ave
Muskegon, MI 49442-3331

Phone

(231) 733-6703

NPI assigned

May 26, 2015

Organization subpart

No

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

Authorized official

Name

Wayne Kohn, DO

Title

Cmo

Phone

(231) 737-1335

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Muskegon Covenant Academy Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 231054

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

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelly Ann Tjapkes, LPC

  • Counselor
  • Muskegon, MI
  • NPI 1508108655

  Professional

  NPD (past)

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1063891968",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Muskegon Covenant Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Haak
• Lindsey Haan, LLMSW
• Tamara Jean Haase
• Lisa Hackbarth
• Keenan L Hacker, DO
• Hackley Community Care Center Inc
• Hackley Community Care Center Inc
• Hackley Community Care Center Inc
• Hackley Community Care Center Inc
• Hackley Community Care Center Inc

• Federally Qualified Health Center (FQHC) in Muskegon, MI
• Providers in Muskegon, MI by specialty
• Federally Qualified Health Center (FQHC) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.