Provider Demographics
NPI:1871508309
Name:REGION II COMMISSION ON SERVICES TO THE AGING
Entity Type:Organization
Organization Name:REGION II COMMISSION ON SERVICES TO THE AGING
Other - Org Name:REGION 2 AREA AGENCY ON AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WETHERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-592-1974
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-0189
Mailing Address - Country:US
Mailing Address - Phone:517-592-1974
Mailing Address - Fax:517-592-1975
Practice Address - Street 1:102 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-0189
Practice Address - Country:US
Practice Address - Phone:517-592-1974
Practice Address - Fax:517-592-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4508793Medicaid
MI4509530Medicaid