Healthcare Provider Details

I. General information

NPI: 1326894148
Provider Name (Legal Business Name): COUNTY OF MECOSTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 06/17/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12954 80TH AVE
MECOSTA MI
49332-9591
US

IV. Provider business mailing address

12954 80TH AVE
MECOSTA MI
49332-9591
US

V. Phone/Fax

Practice location:
  • Phone: 231-972-2884
  • Fax: 231-972-4735
Mailing address:
  • Phone: 231-972-2884
  • Fax: 231-972-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA MALLORY
Title or Position: DIRECTOR
Credential:
Phone: 231-972-2884