Provider Demographics
NPI:1942675525
Name:ISABELLA CITIZENS FOR HEALTH, INC.
Entity type:Organization
Organization Name:ISABELLA CITIZENS FOR HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-953-5191
Mailing Address - Street 1:2790 HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9342
Mailing Address - Country:US
Mailing Address - Phone:989-953-5320
Mailing Address - Fax:989-953-5329
Practice Address - Street 1:2935 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8931
Practice Address - Country:US
Practice Address - Phone:989-779-5270
Practice Address - Fax:989-779-5279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISABELLA CITIZENS FOR HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-08
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-1038Medicare PIN