Alcona Citizens for Health, Inc

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

ALCONA CITIZENS FOR HEALTH, INC

Doing business as

Thunder Bay Junior High School

Practice address

3500 S Third Ave
Alpena, MI 49707-4105

Phone

(989) 736-8157

NPI assigned

Jan 16, 2013

Last updated

Aug 25, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christine Baumgardner

Title

Ceo

Phone

(989) 736-8157

Specialties & licenses 1

Addresses

Other names 1

• Thunder Bay Junior High School Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063759686. Details of each certification follow.

• CCN 231093 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 231093

Legal name

ALPENA PUBLIC SCHOOLS THUNDER BAY JUNIOR HIGH

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 4, 2016

Last certification

Apr 4, 2016

Ownership / control type

For profit – corporation

Facility address

3500 S Third Ave
Alpena, MI 49707

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503619200000",
    "number": "1063759686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 655",
            "city": "ALPENA",
            "state": "MI",
            "postal_code": "49707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 S THIRD AVE",
            "city": "ALPENA",
            "state": "MI",
            "postal_code": "497074105",
            "telephone_number": "989-736-8157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALCONA CITIZENS FOR HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-16",
        "last_updated": "2017-08-25",
        "status": "A",
        "authorized_official_last_name": "BAUMGARDNER",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-736-8157"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thunder Bay Junior High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Social Worker in Alpena, MI
• Providers in Alpena, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.