Provider Demographics
NPI:1457595381
Name:REGION 2 AREA AGENCY ON AGING
Entity Type:Organization
Organization Name:REGION 2 AREA AGENCY ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WAIVER SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOY
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:517-592-1901
Mailing Address - Street 1:102 N MAIN ST
Mailing Address - Street 2:P.O. BOX 189
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-8979
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:49230-8979
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:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4508793Medicaid