Provider Demographics
NPI:1174670459
Name:COUNTY OF GRAND TRAVERSE
Entity Type:Organization
Organization Name:COUNTY OF GRAND TRAVERSE
Other - Org Name:GRAND TRAVERSE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-995-6103
Mailing Address - Street 1:2600 LAFRANIER RD STE A
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4765
Mailing Address - Country:US
Mailing Address - Phone:231-995-6111
Mailing Address - Fax:231-995-6109
Practice Address - Street 1:2600 LAFRANIER RD STE A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4765
Practice Address - Country:US
Practice Address - Phone:231-995-6111
Practice Address - Fax:231-995-6109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAND TRAVERSE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
MI4301028725261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI772813923Medicaid
MI235100410Medicaid
MI773054097Medicaid
MI235100410Medicaid
MI772813923Medicaid