| NPI | 1376040881 |
|---|---|
| Other Name | GREAT LAKES BAY HEALTH CENTERS DAVENPORT |
| Entity Type | Organization |
| Authorized Contact | DAWN CHRISTIAN Provider Enrollment 989-759-6464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2018-04-11 |