1881719086 NPI number — BENZIE LEELANAU DISTRICT HEALTH DEPT

Table of content: (NPI 1881719086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881719086 NPI number — BENZIE LEELANAU DISTRICT HEALTH DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENZIE LEELANAU DISTRICT HEALTH DEPT
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:
Provider Other Organization Name Type Code:
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:
1881719086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6051 FRANKFORT HWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BENZONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-882-4409
Provider Business Mailing Address Fax Number:
231-882-2204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6051 FRANKFORT HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BENZONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-882-4409
Provider Business Practice Location Address Fax Number:
231-882-2204
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THORELL
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
HEALTH OFFICER
Authorized Official Telephone Number:
231-882-2112

Provider Taxonomy Codes

  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3302186 . This is a "MEDICAID HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3302186 . This is a "MOLINA HEALTH CARE OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3302195 . This is a "MOLINA HEALTH CARE OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 233302195 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233302186 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3302195 . This is a "MEDICAID HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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