Provider Demographics
NPI:1619005998
Name:COUNTY OF HOUGHTON
Entity Type:Organization
Organization Name:COUNTY OF HOUGHTON
Other - Org Name:WESTERN U.P. DISTRICT HEALTH DEPARTMENT & SUPERIOR HOME NURSING & HOSP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER AND ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-482-7382
Mailing Address - Street 1:540 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-2031
Mailing Address - Country:US
Mailing Address - Phone:906-482-7382
Mailing Address - Fax:906-482-9410
Practice Address - Street 1:540 DEPOT ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-2031
Practice Address - Country:US
Practice Address - Phone:906-482-7382
Practice Address - Fax:906-482-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N47550Medicare ID - Type UnspecifiedMEDICAL NURTITION THERAPY