Provider Demographics
NPI:1942380134
Name:AREA AGENCY ON AGING OF WESTERN MICHIGAN INC.
Entity Type:Organization
Organization Name:AREA AGENCY ON AGING OF WESTERN MICHIGAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CZERWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-456-5664
Mailing Address - Street 1:1279 CEDAR ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1378
Mailing Address - Country:US
Mailing Address - Phone:616-456-5664
Mailing Address - Fax:616-456-5693
Practice Address - Street 1:1279 CEDAR ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1378
Practice Address - Country:US
Practice Address - Phone:616-456-5664
Practice Address - Fax:616-456-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4509370Medicaid
MI4508908Medicaid