Provider Demographics
NPI:1477955656
Name:WCHC-HAMTRAMCK HEALTH CENTER
Entity Type:Organization
Organization Name:WCHC-HAMTRAMCK HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAREEA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-365-1362
Mailing Address - Street 1:11447 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3040
Mailing Address - Country:US
Mailing Address - Phone:313-365-1362
Mailing Address - Fax:
Practice Address - Street 1:11447 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3040
Practice Address - Country:US
Practice Address - Phone:313-365-1362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty