Provider Demographics
NPI:1871227439
Name:UPPER GREAT LAKES FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:UPPER GREAT LAKES FAMILY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMILA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:906-481-8571
Mailing Address - Street 1:301 EXPLORER ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-2813
Mailing Address - Country:US
Mailing Address - Phone:906-483-1705
Mailing Address - Fax:906-372-3230
Practice Address - Street 1:52125 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-9267
Practice Address - Country:US
Practice Address - Phone:906-483-1705
Practice Address - Fax:906-372-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)