Provider Demographics
NPI:1093981631
Name:CHILDREN'S HEALTH AND THERAPY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CHILDREN'S HEALTH AND THERAPY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-268-6627
Mailing Address - Street 1:4801 WILLOUGHBY RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1000
Mailing Address - Country:US
Mailing Address - Phone:517-268-6627
Mailing Address - Fax:517-268-6628
Practice Address - Street 1:4801 WILLOUGHBY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1000
Practice Address - Country:US
Practice Address - Phone:517-268-6627
Practice Address - Fax:517-268-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4970817Medicaid
MI4970817Medicaid