Healthcare Provider Details

I. General information

NPI: 1366524985
Provider Name (Legal Business Name): REGION IV AREA AGENCY ON AGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LAKEVIEW AVE
SAINT JOSEPH MI
49085-2379
US

IV. Provider business mailing address

2900 LAKEVIEW AVE
SAINT JOSEPH MI
49085-2379
US

V. Phone/Fax

Practice location:
  • Phone: 269-983-0177
  • Fax:
Mailing address:
  • Phone: 269-983-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE VANLANDINGHAM
Title or Position: CEO
Credential:
Phone: 269-983-0177