| Child And Adolescent Health Center | |
|
555 E Wilcox Ave White Cloud MI 49349 | |
| (231) 689-3268 | |
| (231) 689-1030 |
| Full Name | Child And Adolescent Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 555 E Wilcox Ave, White Cloud, Michigan |
| Authorized Official Name and Position | Julie Tatko (CEO) |
| Authorized Official Contact | 2317452743 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Child And Adolescent Health Center 1615 Michigan Ave Baldwin MI 49304-7984 Ph: (231) 745-5045 | Child And Adolescent Health Center 555 E Wilcox Ave White Cloud MI 49349 Ph: (231) 689-3268 |
| NPI Number | 1790067338 |
|---|---|
| Provider Enumeration Date | 09/09/2011 |
| Last Update Date | 11/12/2020 |
| Medicare PECOS PAC ID | 1153215413 |
|---|---|
| Medicare Enrollment ID | O20121009000646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790067338 | NPI | - | NPPES |
| BPS-H80-010523 | Other | FQHC SITE ID | |
| 0D36000 | Other | BLUE CROSS GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Secondary |
Gunnell Senior Care, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3981 W 2 Mile Rd, White Cloud, MI 49349 Phone: 231-245-9390 |