NPIMap

Organization Active NPI

Hackley Community Care Center Inc

Doing business as Holton High School

  • Federally Qualified Health Center (FQHC)
  • Holton, MI
National Provider Identifier
1841844016
Registry record updated Jul 26, 2019
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
Holton High School
Practice address
6477 Syers Rd
Holton, MI 49425-7508
Phone
(231) 733-6820
NPI assigned
Jul 26, 2019
Last updated
Jul 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2019

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

Authorized official

Name
Danielle Koestner, DO
Title
Cmo
Phone
(231) 737-1335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

6477 Syers Rd
Holton, MI 49425-7508

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1629066238MedicaidMI

Other names 1

  • Holton High School Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2285953HCC School Wellness Program at Holton High School6477 Syers Road Suite a, Holton, MI 49425Certificate of waiverJul 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hackley Community Care31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

Locations

6477 Syers Rd
Holton, MI 49425
Phone (231) 733-6820

Practitioners & affiliated clinicians

Practitioners 4

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": "1564099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564099200000",
    "number": "1841844016",
    "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": "6477 SYERS RD",
            "city": "HOLTON",
            "state": "MI",
            "postal_code": "494257508",
            "telephone_number": "231-733-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKLEY COMMUNITY CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-26",
        "last_updated": "2019-07-26",
        "status": "A",
        "authorized_official_last_name": "KOESTNER",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "231-737-1335",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629066238",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holton High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.