| Little House On Mackinaw, Llc | |
|
6988 Mackinaw Rd Bay City MI 48706-9332 | |
| (989) 790-2005 | |
| (989) 790-2002 |
| Full Name | Little House On Mackinaw, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 6988 Mackinaw Rd, Bay City, Michigan |
| Authorized Official Name and Position | Diane Kukulis (SOLE MEMBER) |
| Authorized Official Contact | 9897902005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Little House On Mackinaw, Llc 6988 Mackinaw Rd Bay City MI 48706-9332 Ph: (989) 790-2005 | Little House On Mackinaw, Llc 6988 Mackinaw Rd Bay City MI 48706-9332 Ph: (989) 790-2005 |
| NPI Number | 1639831993 |
|---|---|
| Provider Enumeration Date | 10/13/2021 |
| Last Update Date | 10/13/2021 |
| Certification Date | 10/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639831993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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