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General NPI Number Information
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NPI Number | 1295286458
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Entity Type | Organization
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Legal Business Name | IHA HEALTH SERVICES CORPORATION
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 2020 HOGBACK RD #19
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City | ANN ARBOR
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State | MI
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Zip | 48105-9752
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Country | US
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Telephone | 734-904-7460
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Fax |
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR PO BOX 0446 LOBBY J
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CHIEF OPERATING OFFICER
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Name | CYNTHIA ELLIOTT
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Credential |
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Telephone | 734-747-6766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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