Healthcare Provider Details

I. General information

NPI: 1477654127
Provider Name (Legal Business Name): REGION VII AREA AGENCY ON AGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/21/2022
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5229 LAKESHORE ROAD
FORT GRATIOT MI
48059
US

IV. Provider business mailing address

1615 S EUCLID AVE
BAY CITY MI
48706-3319
US

V. Phone/Fax

Practice location:
  • Phone: 810-388-6300
  • Fax: 810-388-6305
Mailing address:
  • Phone: 989-893-4506
  • Fax: 989-893-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-893-4506