Organization
GREAT LAKES BAY HEALTH CENTERS
Active
Other names
Great Lakes Bay Health Centers Manchester
Organization subpart
No
Provider details
NPI number
Authorized official
LISA GALONASKA (VICE PRESIDENT)
(989) 759-6464
Entity
Organization
Contact information
Practice address
4800 ESCH ROAD, MANCHESTER MIGRANT CAMP, MANCHESTER, MI 48158
(989) 759-6464
(989) 399-8233
Mailing address
501 LAPEER, SAGINAW, MI 48607-1208
(989) 759-6464
(989) 399-8233
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G36111
0G36111 MEDICARE BILL PAY TO
—
Enumeration date
06/12/2007
Last updated
09/19/2016
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