Healthcare Provider Details

I. General information

NPI: 1013007855
Provider Name (Legal Business Name): MCLAREN HEALTH MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N BRADLEY HWY
ROGERS CITY MI
49779-1509
US

IV. Provider business mailing address

761 LAFAYETTE AVENUE
CHEBOYGAN MI
49721
US

V. Phone/Fax

Practice location:
  • Phone: 800-342-7711
  • Fax: 231-268-3700
Mailing address:
  • Phone: 231-627-7157
  • Fax: 231-268-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number043512
License Number StateMI

VIII. Authorized Official

Name: STEVEN DALE LOY
Title or Position: CFO/VICE PRESIDENT
Credential:
Phone: 810-496-8633