Adventure Centre at Pretty Lake

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

261QM0801X Issued in MI

Legal business name

ADVENTURE CENTRE AT PRETTY LAKE

Practice address

9497 Q Ave
Mattawan, MI 49071-8435

Phone

(269) 375-1664

NPI assigned

Oct 21, 2008

Last updated

Oct 21, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Richard Szwaja, MA

Title

Executive Director

Phone

(269) 375-1664

Specialties & licenses 1

Addresses

Other names 1

• ACPL Other name

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1194977314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9497 Q AVE",
            "city": "MATTAWAN",
            "state": "MI",
            "postal_code": "490718435",
            "telephone_number": "269-375-1664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9497 Q AVE",
            "city": "MATTAWAN",
            "state": "MI",
            "postal_code": "490718435",
            "telephone_number": "269-375-1664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTURE CENTRE AT PRETTY LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "SZWAJA",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "269-375-1664",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "261QM0801X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ACPL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Afav Enterprises LLC (Mattawan Village Pharmacy)
• Affinity Health Management LLC
• Makaila Almaguer
• Annette Genovese LCSW
• Mackenzie Paola Barajas

• Community/Behavioral Health Agency in Mattawan, MI
• Providers in Mattawan, MI by specialty
• Community/Behavioral Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.