Healthcare Provider Details

I. General information

NPI: 1942675525
Provider Name (Legal Business Name): ISABELLA CITIZENS FOR HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 HEALTH PKWY
MT PLEASANT MI
48858-8931
US

IV. Provider business mailing address

2790 HEALTH PKWY
MT PLEASANT MI
48858-9342
US

V. Phone/Fax

Practice location:
  • Phone: 989-779-5270
  • Fax: 989-779-5279
Mailing address:
  • Phone: 989-953-5320
  • Fax: 989-953-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN WHITE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-953-5191