MEDICARE: REGION 2 AREA AGENCY ON AGING

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		MI

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	:	1457595381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGION 2 AREA AGENCY ON AGING

Provider Business Mailing Address
First Line	:	102 N MAIN ST
Second Line	:	P.O. BOX 189
City	:	BROOKLYN
State	:	MI
Zip	:	49230-8979
Country	:	US
Telephone Number	:	517-592-1974
Fax Number	:	517-592-1975

Provider Business Practice Location Address
First Line	:	102 N MAIN ST
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-8979
Country	:	US
Telephone Number	:	517-592-1974
Fax Number	:	517-592-1975

Authorized Official
Title or Position	:	WAIVER SERVICES MANAGER
Name	:	MS. BARBARA A STOY
Credential	:	LBSW
Telephone Number	:	517-592-1901

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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