EAGLE VILLAGE (NPI# 1710351598) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710351598 |
| Entity Type | Organization |
| Organization Name | EAGLE VILLAGE |
| Practice Address |
4507 170th Ave Hersey MI 49639-8785 |
| Practice Telephone | 2318322234 |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2015-11-17 |
| Authorized Official Name | CATHEY PRUDHOMME (CEO) |
| Authorized Official Telephone | 2318327259 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 323P00000X | Psychiatric Residential Treatment Facility | Residential Treatment Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EAGLE VILLAGE COUNCIL | 19 Main St, Eagle, AK 99738-0000 |
| New York State Corporations | EAGLE VILLAGE MOTORS, LLC | 99 Thompson St, Fayetteville, Ny 130661909 |
| New York State Corporations | EAGLE VILLAGE PROPERTIES, LLC | 1169 Oak Lane, Bridgeport, Ny 13230 |
| Street Address |
4507 170TH AVE |
| City | HERSEY |
| State | MI |
| Zip Code | 49639-8785 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134390354 | Donald Clyde Guernsey | Marriage & Family Therapist | 4507 170th Ave, Hersey, MI 49639-8785 | 2008-03-14 |
| 1497384762 | Phylicia Rochelle Rosema | Social Worker | 4507 170th Ave, Hersey, MI 49639-8785 | 2020-04-07 |
| 1437684990 | Micaela Chappelle | Social Worker | 4507 170th Ave, Hersey, MI 49639-8785 | 2017-04-21 |
| 1720513252 | Cathey Prudhomme | Counselor | 4507 170th Ave, Hersey, MI 49639-8785 | 2017-04-21 |
| 1386183796 | Misty Oebel | Counselor | 4507 170th Ave, Hersey, MI 49639 | 2017-02-17 |
| 1154860732 | Kaycie Sue Jacobs | Social Worker | 4507 170th Ave, Hersey, MI 49639-8785 | 2017-02-16 |
| 1417496092 | Kimberly K. Venema | Counselor | 4507 170th Ave, Hersey, MI 49639-8785 | 2017-02-16 |
| 1699214270 | Daniel F. Wesche | Counselor | 4507 170th Ave, Hersey, MI 49639-8785 | 2017-02-16 |
| 1972042554 | Angela Knapp | Social Worker | 4507 170th Ave, Hersey, MI 49639-8785 | 2017-02-16 |
| 1346789179 | Ame Mae Edstrom | Marriage & Family Therapist | 4507 170th Ave, Hersey, MI 49639-8785 | 2017-02-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285134494 | Alicia Elizabeth Kelenske | Behavior Technician | 13444 Carlson Rd, Hersey, MI 49639 | 2018-02-14 |
| 1356603849 | Loretta M Thompson | Occupational Therapist | 5044 175th Ave, Hersey, MI 49639-8468 | 2012-06-12 |
| 1659910966 | Brianna Nicole Thompson | Social Worker | 3391 180th Ave, Hersey, MI 49639-8577 | 2020-01-03 |
| 1982126496 | Allyson Frederick | Behavior Technician | 18592 3 Mile Rd, Hersey, MI 49639-8733 | 2017-07-17 |
| Taxonomy Code | 323P00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Psychiatric Residential Treatment Facility |
| A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary |
| Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598120925 | Faith's Place LLC | Psychiatric Residential Treatment Facility | 16725 Blackstone Street, Detroit, MI 48219 | 2015-12-30 |
| 1164837431 | Common Ground | Psychiatric Residential Treatment Facility | 1200 Telegraph Rd, Pontiac, MI 48341 | 2014-06-25 |
| 1104249374 | Common Ground | Psychiatric Residential Treatment Facility | 1410 Telegraph Road, Pontiac, MI 48332 | 2014-01-24 |
| 1881961498 | The Meadows Specialized Residential Program | Psychiatric Residential Treatment Facility | 55377 Walterspaugh Rd, Mendon, MI 49072-9545 | 2011-11-27 |
| 1164753828 | Is-care Cls, Inc. | Psychiatric Residential Treatment Facility | 1777 N Rademacher St, Detroit, MI 48209-2049 | 2010-01-20 |
| 1518129295 | Advance Care Incorporated | Psychiatric Residential Treatment Facility | 34932 Ecorse Rd, Romulus, MI 48174-1642 | 2008-06-25 |
| 1356511372 | Detroit Behavioral Institute, LLC | Psychiatric Residential Treatment Facility | 3500 John R St, Detroit, MI 48201-2402 | 2008-03-05 |
| 1245375823 | D & M Consultants, Inc | Psychiatric Residential Treatment Facility | 25071 West Ten Mile Road, Southfield, MI 48033 | 2007-02-21 |
| 1578582672 | Ccs/lansing, Inc | Psychiatric Residential Treatment Facility | 101 W Townsend Rd, Saint Johns, MI 48879-9200 | 2006-07-19 |
| 1154781615 | Detroit Vamc | Psychiatric Residential Treatment Facility | 4777 E Outer Dr, Detroit, MI 48234-3241 | 2016-02-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.