Healthcare Provider Details

I. General information

NPI: 1760443584
Provider Name (Legal Business Name): DISTRICT HEALTH DEPARTMENT NO. 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS CIR SUITE 200
ALPENA MI
49707-1444
US

IV. Provider business mailing address

100 WOODS CIR SUITE 200
ALPENA MI
49707-1444
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-4507
  • Fax: 989-358-7997
Mailing address:
  • Phone: 989-356-4507
  • Fax: 989-358-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN BRUNING
Title or Position: ADMINISTRATIVE HEALTH OFFICER
Credential:
Phone: 989-356-4507