Provider Demographics
NPI:1376092064
Name:HEALTH NET OF WEST MICHIGAN
Entity Type:Organization
Organization Name:HEALTH NET OF WEST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIRKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:616-632-1010
Mailing Address - Street 1:620 CENTURY AVE SW
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4977
Mailing Address - Country:US
Mailing Address - Phone:616-726-8204
Mailing Address - Fax:616-726-8205
Practice Address - Street 1:620 CENTURY AVE SW
Practice Address - Street 2:SUITE 210
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4977
Practice Address - Country:US
Practice Address - Phone:616-726-8204
Practice Address - Fax:616-726-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management