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General NPI Number Information
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NPI Number | 1760888002
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Entity Type | Organization
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Legal Business Name | ALCONA CITIZENS FOR HEALTH, INC
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 4999 HERRON RD
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City | HERRON
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State | MI
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Zip | 49744-9600
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Country | US
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Telephone | 989-358-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 4999 HERRON RD
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City | HERRON
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State | MI
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Zip | 49744-9600
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Country | US
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Telephone | 989-358-5700
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Fax |
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Authorized Official
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Title or Position | INS CREDENTIALING
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Name | ELIZABETH GODDARD
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Credential |
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Telephone | 989-736-9815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801088331
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License Number State | MI
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