Provider Demographics
NPI:1346304748
Name:HEALTHLAND P C
Entity Type:Organization
Organization Name:HEALTHLAND P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-445-2911
Mailing Address - Street 1:31700 VAN DYKE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-7949
Mailing Address - Country:US
Mailing Address - Phone:586-445-2911
Mailing Address - Fax:586-871-2036
Practice Address - Street 1:31700 VAN DYKE AVE STE H
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7949
Practice Address - Country:US
Practice Address - Phone:586-445-2911
Practice Address - Fax:586-871-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP08300Medicare ID - Type Unspecified