Healthcare Provider Details

I. General information

NPI: 1376750091
Provider Name (Legal Business Name): EAST JORDAN FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 S M 88 HWY
BELLAIRE MI
49615-9082
US

IV. Provider business mailing address

4955 S M 88 HWY
BELLAIRE MI
49615-9082
US

V. Phone/Fax

Practice location:
  • Phone: 231-533-8649
  • Fax:
Mailing address:
  • Phone: 231-533-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DIANE HAWLEY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 231-536-2206