MEDICARE: LEELANAU COUNTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1114011673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEELANAU COUNTY

Provider Business Mailing Address
First Line	:	7401 E. DUCK LAKE RD
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653
Country	:	US
Telephone Number	:	231-256-7590
Fax Number	:	231-256-2430

Provider Business Practice Location Address
First Line	:	7401 E. DUCK LAKE RD
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653
Country	:	US
Telephone Number	:	231-256-7590
Fax Number	:	231-256-2430

Authorized Official
Title or Position	:	CHAIR, LCBOC
Name	:	MR. ROBERT HAWLEY
Credential	:
Telephone Number	:	231-256-9711

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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Directions to “LEELANAU COUNTY ” Practice Location

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