Provider Demographics
NPI:1679653422
Name:COUNTY OF OTTAWA
Entity Type:Organization
Organization Name:COUNTY OF OTTAWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-393-5781
Mailing Address - Street 1:12251 JAMES ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9675
Mailing Address - Country:US
Mailing Address - Phone:616-393-5781
Mailing Address - Fax:616-393-5643
Practice Address - Street 1:12251 JAMES ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9675
Practice Address - Country:US
Practice Address - Phone:616-393-5781
Practice Address - Fax:616-393-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5100822Medicaid
MI1678314Medicaid
MI1678299Medicaid
MI5100813Medicaid
MI5100822Medicaid