Provider Demographics
NPI:1427273572
Name:CHARLEVOIX COUNTY COA
Entity type:Organization
Organization Name:CHARLEVOIX COUNTY COA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RNBSN
Authorized Official - Phone:231-237-0103
Mailing Address - Street 1:207 W ANTRIM ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1389
Mailing Address - Country:US
Mailing Address - Phone:231-237-0103
Mailing Address - Fax:231-237-0105
Practice Address - Street 1:207 W ANTRIM ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1389
Practice Address - Country:US
Practice Address - Phone:231-237-0103
Practice Address - Fax:231-237-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health