1376512236 NPI number — NEWAYGO COUNTY MENTAL HEALTH BOARD

Table of content: (NPI 1376512236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376512236 NPI number — NEWAYGO COUNTY MENTAL HEALTH BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWAYGO COUNTY MENTAL HEALTH BOARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376512236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1049 E NEWELL ST
Provider Second Line Business Mailing Address:
PO BOX 867
Provider Business Mailing Address City Name:
WHITE CLOUD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49349-8795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-689-7330
Provider Business Mailing Address Fax Number:
231-689-7345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1049 E NEWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE CLOUD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49349-8795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-689-7330
Provider Business Practice Location Address Fax Number:
231-689-7345
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
231-689-7330

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  4301045669 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043260177 . This is a "NPA - LAFLEUR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1417139692 . This is a "NPI - DR. ALT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1578686820 . This is a "NPI - BRITT MILLER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1225066079 . This is a "NPI - GUNNELL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1285674028 . This is a "NPI - LAPO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1386969996 . This is a "NPI - PHARMACY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1417164575 . This is a "NPI - ZAK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1538325543 . This is a "NPI - JO MEYER, LMSW" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1708066 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P57070010 . This is a "JILLAINE RUPPEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P57070001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1740629450 . This is a "KATHLEEN SMITH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1780816520 . This is a "NPI - JILLAINE RUPPEL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4892416 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 700F260140 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P57070002 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P57070009 . This is a "JO MEYER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P57070011 . This is a "MEDICARE - BRITT MILLER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1184972309 . This is a "SED WAIVER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1376512236 . This is a "NPI - AGENCY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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