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General NPI Number Information
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NPI Number | 1376092064
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Entity Type | Organization
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Legal Business Name | HEALTH NET OF WEST MICHIGAN
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 620 CENTURY AVE SW SUITE 210
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4977
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Country | US
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Telephone | 616-726-8204
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Fax | 616-726-8205
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Provider Business Mailing Address
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Address Line | 620 CENTURY AVE SW SUITE 210
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4977
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Country | US
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Telephone | 616-726-8204
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Fax | 616-726-8205
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MAUREEN T KIRKWOOD
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Credential | MPH
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Telephone | 616-632-1010
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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 |
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License Number State |
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