Provider Demographics
NPI:1720018823
Name:MINDEN CITY COMMUNITY HEALTHCARE OUTREACH
Entity Type:Organization
Organization Name:MINDEN CITY COMMUNITY HEALTHCARE OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:810-385-2290
Mailing Address - Street 1:28 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3645
Mailing Address - Country:US
Mailing Address - Phone:810-385-2290
Mailing Address - Fax:810-385-2290
Practice Address - Street 1:28 DEER CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059
Practice Address - Country:US
Practice Address - Phone:989-864-5328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003334261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health