Basic Information
| Provider Information | |||||||||
| NPI: | 1144688342 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALCONA CITIZENS FOR HEALTH, INC | ||||||||
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| OtherOrganizationName: | AHC-ALPENA HIGH SCHOOL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 279 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487420279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897368157 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3303 S THIRD AVE | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497073307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893585200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2016 | ||||||||
| LastUpdateDate: | 02/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | BAUMGARDNER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9897368157 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.