Healthcare Provider Details

I. General information

NPI: 1174965115
Provider Name (Legal Business Name): AREA AGENCY ON AGING OF WESTERN MICHIGAN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 EAGLE CREST DR NE
GRAND RAPIDS MI
49525-7005
US

IV. Provider business mailing address

3215 EAGLE CREST DR NE
GRAND RAPIDS MI
49525-7005
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-5664
  • Fax: 616-456-5692
Mailing address:
  • Phone: 616-456-5664
  • Fax: 616-456-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number874121
License Number StateMI

VIII. Authorized Official

Name: MR. THOMAS EDWARD CZERWINSKI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-222-7001