| NPI | 1104177195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN WHITE CEO 989-953-5191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: #LAL000164) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2020-11-16 |