Provider Demographics
NPI:1184972309
Name:NEWAYGO COUNTY MENTAL HEALTH BOARD
Entity type:Organization
Organization Name:NEWAYGO COUNTY MENTAL HEALTH BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:231-689-7330
Mailing Address - Street 1:1049 E NEWELL ST
Mailing Address - Street 2:P O BOX 867
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-8795
Mailing Address - Country:US
Mailing Address - Phone:231-689-7330
Mailing Address - Fax:231-689-7345
Practice Address - Street 1:1049 E NEWELL ST
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8795
Practice Address - Country:US
Practice Address - Phone:231-689-7330
Practice Address - Fax:231-689-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
153825543OtherNPI - JO MEYER LMSW
1780816520OtherNPI - JILLAINE RUPPEL
MI4892416Medicaid
MI4359826Medicaid
P57070001OtherMEDICARE PTAN
P57070010OtherJILLAINE RUPPEL
1376512236OtherNPI - AGENCY
700F260140OtherBLUE CROSS/BLUE SHIELD
1386969996OtherNPI - PHARMACY
1417139692OtherNPI - DR. ALT
MI1708066Medicaid
P57070002OtherMEDICARE PTAN
MIP57070009OtherJO MEYER
MI1708066Medicaid
0P57070Medicare PIN