Healthcare Provider Details

I. General information

NPI: 1619005998
Provider Name (Legal Business Name): COUNTY OF HOUGHTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 DEPOT ST
HANCOCK MI
49930-2031
US

IV. Provider business mailing address

540 DEPOT ST
HANCOCK MI
49930-2031
US

V. Phone/Fax

Practice location:
  • Phone: 906-482-7382
  • Fax: 906-482-9410
Mailing address:
  • Phone: 906-482-7382
  • Fax: 906-482-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MR. GUY ST. GERMAIN
Title or Position: HEALTH OFFICER AND ADMINSTRATOR
Credential:
Phone: 906-482-7382