MEDICARE: MID MICHIGAN COMMUNITY ACTION AGENCY

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1417257106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID MICHIGAN COMMUNITY ACTION AGENCY

Provider Business Mailing Address
First Line	:	1521 WASHINGTON ST
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-5685
Country	:	US
Telephone Number	:	989-832-7310
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 WASHINGTON ST
Second Line	:
City	:	MIDLAND
State	:	MI
Zip	:	48640-5685
Country	:	US
Telephone Number	:	989-832-7310
Fax Number	:

Authorized Official
Title or Position	:	EARLY CHILDHOOD SERVICES DIRECTOR
Name	:	JOLEEN GOLDEN
Credential	:
Telephone Number	:	989-832-7310

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	10/27/2010

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