Provider Demographics
NPI:1700099926
Name:INGHAM COUNTY YOUTH CENTER
Entity Type:Organization
Organization Name:INGHAM COUNTY YOUTH CENTER
Other - Org Name:INGHAM COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:517-887-4428
Mailing Address - Street 1:700 E JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6832
Mailing Address - Country:US
Mailing Address - Phone:517-887-4330
Mailing Address - Fax:
Practice Address - Street 1:700 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6832
Practice Address - Country:US
Practice Address - Phone:517-887-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM77560Medicare ID - Type UnspecifiedNURSE PRACTITIONER
0C36051Medicare ID - Type Unspecified