Provider Demographics
NPI:1528382538
Name:GRAND TRAVERSE COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GRAND TRAVERSE COUNTY HEALTH DEPARTMENT
Other - Org Name:K-TOWN YOUTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING TECHNICIAN
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:
Practice Address - Street 1:112 S BROWNSON AVE
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649
Practice Address - Country:US
Practice Address - Phone:231-263-5895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAND TRAVERSE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-19
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center