Provider Demographics
NPI:1275079725
Name:ALCONA CITIZENS FOR HEALTH, INC.
Entity Type:Organization
Organization Name:ALCONA CITIZENS FOR HEALTH, INC.
Other - Org Name:ALCONA HEALTH CENTER PETOSKEY CHILD HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-736-8157
Mailing Address - Street 1:177 N BARLOW RD
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48740-9607
Mailing Address - Country:US
Mailing Address - Phone:989-736-8157
Mailing Address - Fax:989-358-3762
Practice Address - Street 1:2390 MITCHELL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8965
Practice Address - Country:US
Practice Address - Phone:231-487-2250
Practice Address - Fax:231-348-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty