Healthcare Provider Details

I. General information

NPI: 1457595381
Provider Name (Legal Business Name): REGION 2 AREA AGENCY ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MAIN ST
BROOKLYN MI
49230-8979
US

IV. Provider business mailing address

102 N MAIN ST P.O. BOX 189
BROOKLYN MI
49230-8979
US

V. Phone/Fax

Practice location:
  • Phone: 517-592-1974
  • Fax: 517-592-1975
Mailing address:
  • Phone: 517-592-1974
  • Fax: 517-592-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. BARBARA A STOY
Title or Position: WAIVER SERVICES MANAGER
Credential: LBSW
Phone: 517-592-1901