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General NPI Number Information
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NPI Number | 1174965115
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Entity Type | Organization
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Legal Business Name | AREA AGENCY ON AGING OF WESTERN MICHIGAN INC.
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 3215 EAGLE CREST DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7005
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Country | US
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Telephone | 616-456-5664
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Fax | 616-456-5692
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Provider Business Mailing Address
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Address Line | 3215 EAGLE CREST DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7005
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Country | US
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Telephone | 616-456-5664
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Fax | 616-456-5692
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. THOMAS EDWARD CZERWINSKI
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Credential |
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Telephone | 616-222-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 874121
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License Number State | MI
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