Provider Demographics
NPI:1790195105
Name:CHATHAM KENT HEALTH ALLIANCE
Entity Type:Organization
Organization Name:CHATHAM KENT HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:
Authorized Official - Last Name:TETZLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:CGA
Authorized Official - Phone:519-352-6400
Mailing Address - Street 1:80 GRAND AVENUE
Mailing Address - Street 2:PO BOX 2030
Mailing Address - City:CHATHAM
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N7M5L9
Mailing Address - Country:CA
Mailing Address - Phone:519-352-6400
Mailing Address - Fax:519-380-2877
Practice Address - Street 1:80 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:ONTARIO
Practice Address - Zip Code:N7M5L9
Practice Address - Country:CA
Practice Address - Phone:519-352-6400
Practice Address - Fax:519-380-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital