Provider Demographics
NPI:1417997578
Name:MYMICHIGAN MEDICAL CENTER ALPENA
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER ALPENA
Other - Org Name:MYMICHIGAN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARWEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-8071
Mailing Address - Street 1:1521 W. CHISHOLM STREET
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1401
Mailing Address - Country:US
Mailing Address - Phone:989-356-8004
Mailing Address - Fax:989-356-8034
Practice Address - Street 1:1521 W. CHISHOLM STREET
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1401
Practice Address - Country:US
Practice Address - Phone:989-356-8004
Practice Address - Fax:989-356-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2902550Medicaid