Healthcare Provider Details

I. General information

NPI: 1497968754
Provider Name (Legal Business Name): MYMICHIGAN MEDICAL CENTER ALPENA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CHISHOLM ST
ALPENA MI
49707
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-0001
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-7390
  • Fax: 989-356-8013
Mailing address:
  • Phone: 989-356-7390
  • Fax: 989-356-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number040010
License Number StateMI

VIII. Authorized Official

Name: CHARLES SHERWIN
Title or Position: PRESIDENT
Credential:
Phone: 989-356-7390