Provider Demographics
NPI:1962595983
Name:MCLAREN HEALTH MANAGEMENT GROUP
Entity type:Organization
Organization Name:MCLAREN HEALTH MANAGEMENT GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-496-8633
Mailing Address - Street 1:1515 CAL DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-9016
Mailing Address - Country:US
Mailing Address - Phone:810-496-8640
Mailing Address - Fax:231-627-1652
Practice Address - Street 1:761 LAFAYETTE AVENUE
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721
Practice Address - Country:US
Practice Address - Phone:231-627-7157
Practice Address - Fax:231-627-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI163520251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08708OtherBLUE CROSS/BLUE SHIELD
MI2698527Medicaid
MI08708OtherBLUE CROSS/BLUE SHIELD