MEDICARE: ALAND DEWON STAMPS CCAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1797	OTHER		CCAR RECOVERY COACH ACADEMY TRAINER
2	179	OTHER		CCAR

General Provider Information

NPI Number	:	1174283170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAND DEWON STAMPS CCAR

Provider Business Mailing Address
First Line	:	3442 KIESEL RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2446
Country	:	US
Telephone Number	:	989-391-4046
Fax Number	:	989-391-4047

Provider Business Practice Location Address
First Line	:	3442 KIESEL RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2446
Country	:	US
Telephone Number	:	989-391-4046
Fax Number	:	989-391-4047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2021
Last Update Date	:	12/19/2021

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