Provider Demographics
NPI:1093063307
Name:COUNTY OF GENESEE OFFICE OF CONTROLLER
Entity Type:Organization
Organization Name:COUNTY OF GENESEE OFFICE OF CONTROLLER
Other - Org Name:GENESEE COMMUNITY HEALTH CENTER-CENTER CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-257-3707
Mailing Address - Street 1:725 MASON ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2421
Mailing Address - Country:US
Mailing Address - Phone:810-257-3737
Mailing Address - Fax:810-257-3785
Practice Address - Street 1:422 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2404
Practice Address - Country:US
Practice Address - Phone:810-287-8144
Practice Address - Fax:810-257-3785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESEE COUNTY COMMUNITY MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)