Healthcare Provider Details

I. General information

NPI: 1720018823
Provider Name (Legal Business Name): MINDEN CITY COMMUNITY HEALTHCARE OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 DEER CREEK DRIVE
FORT GRATIOT MI
48059
US

IV. Provider business mailing address

28 DEER CREEK DR
BURTCHVILLE MI
48059-3645
US

V. Phone/Fax

Practice location:
  • Phone: 989-864-5328
  • Fax:
Mailing address:
  • Phone: 810-385-2290
  • Fax: 810-385-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number5601003334
License Number StateMI

VIII. Authorized Official

Name: MS. LINDSAY KATHRYN BROWN
Title or Position: CEO
Credential: P.A.-C
Phone: 810-385-2290