MEDICARE: COUNTRYVIEW CASE MANAGEMENT LLC.

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1407521941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTRYVIEW CASE MANAGEMENT LLC.

Provider Business Mailing Address
First Line	:	3990 W WALTON BLVD STE A
Second Line	:
City	:	WATERFORD TWP
State	:	MI
Zip	:	48329-4288
Country	:	US
Telephone Number	:	248-922-5700
Fax Number	:	248-922-5709

Provider Business Practice Location Address
First Line	:	3990 W WALTON BLVD STE A
Second Line	:
City	:	WATERFORD TWP
State	:	MI
Zip	:	48329-4288
Country	:	US
Telephone Number	:	248-922-5700
Fax Number	:	248-922-5709

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIE ANN BISE
Credential	:	RN
Telephone Number	:	248-922-5700

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/16/2021

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