Provider Demographics
NPI:1659983872
Name:NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY
Entity Type:Organization
Organization Name:NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-547-6523
Mailing Address - Street 1:220 W GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1631
Mailing Address - Country:US
Mailing Address - Phone:231-547-6523
Mailing Address - Fax:231-547-6238
Practice Address - Street 1:95 LIVINGSTON BLVD
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9464
Practice Address - Country:US
Practice Address - Phone:989-731-6878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory