Provider Demographics
NPI:1790869436
Name:HANNAHVILLE INDIAN COMMUNITY
Entity Type:Organization
Organization Name:HANNAHVILLE INDIAN COMMUNITY
Other - Org Name:HANNAHVILLE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH & HUMAN SERVICES
Authorized Official - Prefix:MISS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MESHIGAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-466-2782
Mailing Address - Street 1:N14911 HANNAHVILLE B-1 RD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:MI
Mailing Address - Zip Code:49896-9728
Mailing Address - Country:US
Mailing Address - Phone:906-466-2932
Mailing Address - Fax:
Practice Address - Street 1:N15019 HANNAHVILLE B1 RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:MI
Practice Address - Zip Code:49896
Practice Address - Country:US
Practice Address - Phone:906-466-2782
Practice Address - Fax:906-466-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherFEDERAL TAX EIN
MI=========OtherFEDERAL TAX EIN