Intercare Community Health Network
Organization Active NPI Federally Qualified Health Center (FQHC) · Eau Claire, MI
NPI 1336701119 · NPPES record last updated Jul 2, 2019
Key facts
- NPI
- 1336701119
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- INTERCARE COMMUNITY HEALTH NETWORK
- Practice address
- 7450 Hochberger Rd RM 15a
Eau Claire, MI 49111-9762 - Phone
- (269) 461-6947
- NPI assigned
- Jul 2, 2019
- Organization subpart
- No
Authorized official
- Name
- Velma Hendershott
- Title
- Ceo/President
- Phone
- (269) 427-7937
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 15
Practitioners 116
-
Francine M Bruder, M.D.
-
Robert E Dempsey, D.O.
-
Heather Renee Figueroa, M.D.
-
Kenneth Forsman, MD
-
Ian Andrew Jackson, M.D.
-
Sachcihidana Jha, M.D.
-
Mark E Obrien, MD
-
David Perez, DO
-
Claudia Olivia Pozo, MS, LLPC
-
David A Puzycki, MD
-
Grace Siekman, MSW
-
Lana Zarlenga, MD
-
Jay Kelly Kennard, M.D.
-
David E Collins, MD
-
Deborah Matwetwe, FNP
-
Timothy Amborski, NP
-
Teresa Ansinn, ANP
-
Mary C Ball, M.D.
-
John L Bard, MD
-
Erin K Beckman, CNM
-
Amanda Cayo Bentley, DNP, FNP-C
-
Miguel Enrique Bermeo, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Federally qualified health center certification: CCN 231142
- Legal name
- INTERCARE COMMUNITY HEALTH NETWORK
- Doing business as
- INTERCARE CHILD AND ADOLESCENT BEHAVIORAL HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 11, 2019
- Last certification
- Sep 11, 2019
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Proprietary
- Incorporated
- Sep 1, 1971 in MI
- Enrollment address
- 7450 Hochberger Rd
RM 15a
Eau Claire, MI 49111-9762
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Ron Karpanty |
Corporate Director |
Jan 1, 2019 | |
| Velma Hendershot |
Corporate Officer |
Jan 1, 1987 | |
| Corporate Director |
Jan 1, 1987 | ||
| Margaret Adams |
Corporate Director |
May 19, 2015 | |
| Karen Freeburn |
Corporate Director |
Jan 1, 2002 | |
| John McElwee |
Corporate Director |
Nov 20, 2023 | |
| W-2 Managing Employee |
Nov 20, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190912002295 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 9537061254 | Practice locations: Eau Claire, MI |
National Provider Directory
- Tax ID family
- Intercare Community Health Network
Locations
870 Colfax Ave
Benton Harbor, MI 49022
Phone (269) 605-1277
7450 Hochberger Rd
Rm 15A
Eau Claire, MI 49111
Phone (269) 461-6947
11637 M 140
South Haven, MI 49090
Phone (616) 637-3528
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor |
101YS0200X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
7450 Hochberger Rd RM 15a
Eau Claire, MI 49111-9762
Mailing address
50 Industrial Park Rd
Bangor, MI 49013-1246
Phone (269) 427-7937
Other names
- InterCare Child and Adolescent Behavioral Health Center
Other providers in Eau Claire, MI
- Denise J Bowen
- Mark Cudanin
- Empowher Physical Therapy & Wellness PLLC
- Catherine Rose Hopkins
- Lani Leigh Hoshaw
- Intercare Community Health Network
- Intercare Community Health Network
- Taylor Krugh
- Keesha McKee
- Maximino Alfredo Mejia
All providers in Eau Claire, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.