Healthcare Provider Details

I. General information

NPI: 1679653422
Provider Name (Legal Business Name): COUNTY OF OTTAWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12251 JAMES ST SUITE 400
HOLLAND MI
49424-9675
US

IV. Provider business mailing address

12251 JAMES ST SUITE 400
HOLLAND MI
49424-9675
US

V. Phone/Fax

Practice location:
  • Phone: 616-393-5781
  • Fax: 616-393-5643
Mailing address:
  • Phone: 616-393-5781
  • Fax: 616-393-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. LISA STEFANOVSKY
Title or Position: HEALTH OFFICER
Credential:
Phone: 616-393-5781