Basic Information
| Provider Information | |||||||||
| NPI: | 1164970307 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AHC-OTTAWA ELEMENTARY SCHOOL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 871 KALAMAZOO AVE | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497703216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313482130 | ||||||||
| FaxNumber: | 2313482302 | ||||||||
| Practice Location | |||||||||
| Address1: | 871 KALAMAZOO AVE | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497703216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313482130 | ||||||||
| FaxNumber: | 2313482302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2016 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | BAUMGARDNER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9897368157 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | School | 1041S0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.