Healthcare Provider Details

I. General information

NPI: 1194767996
Provider Name (Legal Business Name): STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CHAMBERS RD
CARO MI
48723
US

IV. Provider business mailing address

PO BOX 30437
LANSING MI
48909-7937
US

V. Phone/Fax

Practice location:
  • Phone: 989-672-9261
  • Fax: 989-673-6749
Mailing address:
  • Phone: 517-241-5544
  • Fax: 517-335-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301000559
License Number StateMI

VIII. Authorized Official

Name: JEFFERY WIEFERICH
Title or Position: SENIOR EXECUTIVE
Credential:
Phone: 517-335-0499