MEDICARE: NORTH COUNTRY COMMUNITY MENTAL HEALTH

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366760381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COUNTRY COMMUNITY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	1 MACDONALD DR
Second Line	:	SUITE A
City	:	PETOSKEY
State	:	MI
Zip	:	49770-4406
Country	:	US
Telephone Number	:	231-347-7890
Fax Number	:	231-347-1241

Provider Business Practice Location Address
First Line	:	1 MACDONALD DR
Second Line	:	SUITE A
City	:	PETOSKEY
State	:	MI
Zip	:	49770-4406
Country	:	US
Telephone Number	:	231-347-7890
Fax Number	:	231-347-1241

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ALEXIS KACZYNSKI
Credential	:
Telephone Number	:	231-347-7890

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	05/14/2010

Similar Medicare Providers

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Practice Location Address:

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1760623433 — MR. MICHAEL JOHN LUCIDO LLP
Practice Location Address:

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1992386940 — DR. KENNETH W VERBOS II MD
Practice Location Address:

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Directions to “NORTH COUNTRY COMMUNITY MENTAL HEALTH ” Practice Location

Language	Start Address	Practice Location

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