Provider Demographics
NPI:1477502938
Name:NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY
Entity Type:Organization
Organization Name:NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY
Other - Org Name:DISTRICT HEALTH DEPARTMENT #3
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REIMBURSEMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-547-6523
Mailing Address - Street 1:220 W. GARFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720
Mailing Address - Country:US
Mailing Address - Phone:231-547-6523
Mailing Address - Fax:231-547-6238
Practice Address - Street 1:220 W. GARFIELD STREET
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720
Practice Address - Country:US
Practice Address - Phone:231-547-6523
Practice Address - Fax:231-547-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5174058Medicaid
MI0E043OtherHOME HEALTH BCBSM
MI0E043OtherHOME HEALTH BCBSM