1144559568 NPI number — ALCONA CITIZENS FOR HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144559568 NPI number — ALCONA CITIZENS FOR HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALCONA CITIZENS FOR HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALCONA HEALTH CENTER-TIGER EXTENSION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144559568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 655
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPENA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-736-8157
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 N. BARLOW ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-736-8716
Provider Business Practice Location Address Fax Number:
989-736-3829
Provider Enumeration Date:
12/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SPENCER
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
989-358-0673

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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