Active NPI
Grand Lake Health Center LLC
- Family Nurse Practitioner
- Alpena, MI
National Provider Identifier
1669712907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4704151039
- Legal business name
- GRAND LAKE HEALTH CENTER LLC
- Practice address
- 1691 M 32 W
Suite 300
Alpena, MI 49707-8210 - Phone
- (989) 354-0860
- Fax
- (989) 354-0880
- NPI assigned
- Feb 24, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Coreen Jean Williams, FNP
- Title
- Executive Director/Owner
- Phone
- (989) 354-0860
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704151039 | MI | Primary |
Addresses
Primary practice location
1691 M 32 W
Suite 300
Alpena, MI 49707-8210
Mailing address
1691 M 32 W
Suite 300
Alpena, MI 49707-8210
Phone (989) 354-0860
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11905624 | Other | MI | CAQH |
| 0870556 | Other | MI | BCBSM |
| 500027624 | Other | MI | RAILROAD MEDICARE |
| 7000525321 | Other | MI | PRIORITY HEALTH |
| 4485877 | Medicaid | MI |
Other names 1
- Journey Health Center
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361664000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1371427200000",
"number": "1669712907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1691 M 32 W",
"address_2": "SUITE 300",
"city": "ALPENA",
"state": "MI",
"postal_code": "497078210",
"telephone_number": "989-354-0860",
"fax_number": "989-354-0880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1691 M 32 W",
"address_2": "SUITE 300",
"city": "ALPENA",
"state": "MI",
"postal_code": "497078210",
"telephone_number": "989-354-0860",
"fax_number": "989-354-0880"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GRAND LAKE HEALTH CENTER LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-02-24",
"last_updated": "2013-06-17",
"status": "A",
"authorized_official_last_name": "WILLIAMS",
"authorized_official_first_name": "COREEN",
"authorized_official_middle_name": "JEAN",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR/OWNER",
"authorized_official_telephone_number": "989-354-0860",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "FNP"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704151039",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11905624",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "0870556",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "500027624",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTH",
"identifier": "7000525321",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4485877",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Journey Health Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Alpena, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.