Healthcare Provider Details

I. General information

NPI: 1518957208
Provider Name (Legal Business Name): MANISTEE BENZIE CMH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 FRANKFORT HWY SUITE 200
BENZONIA MI
49616-9558
US

IV. Provider business mailing address

310 GLOCHESKI DR PO BOX 335
MANISTEE MI
49660-2639
US

V. Phone/Fax

Practice location:
  • Phone: 877-398-2013
  • Fax: 231-882-2195
Mailing address:
  • Phone: 877-398-2013
  • Fax: 231-723-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. DONNA NIEMAN
Title or Position: FINANCE OFFICER
Credential:
Phone: 877-398-2013