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General NPI Number Information
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NPI Number | 1568819464
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Entity Type | Organization
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Legal Business Name | LAKE GOGEBIC SENIOR CITIZENS CLUB, INC
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 109 PINE STREET
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City | BERGLAND
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State | MI
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Zip | 49910-0361
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Country | US
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Telephone | 906-575-3461
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Fax | 906-575-3462
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Provider Business Mailing Address
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Address Line | PO BOX 361
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City | BERGLAND
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State | MI
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Zip | 49910-0361
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Country | US
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Telephone | 906-575-3461
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Fax | 906-575-3462
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOAN H HARRIS
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Credential |
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Telephone | 906-575-3461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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