Provider Demographics
NPI:1033130083
Name:MCLAREN HEALTH MANAGEMENT GROUP
Entity Type:Organization
Organization Name:MCLAREN HEALTH MANAGEMENT GROUP
Other - Org Name:MCLAREN LONG-TERM CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP-CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-496-8633
Mailing Address - Street 1:1454 W CENTER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-2139
Mailing Address - Country:US
Mailing Address - Phone:989-316-4280
Mailing Address - Fax:855-266-2822
Practice Address - Street 1:1454 W CENTER RD STE 2
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2139
Practice Address - Country:US
Practice Address - Phone:989-316-4280
Practice Address - Fax:855-266-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010092363336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123153OtherPK
MI2780798Medicaid
2123153OtherPK