| Region Iv Area Agency On Aging, Inc | |
|
2900 Lakeview Ave Saint Joseph MI 49085-2379 | |
| (269) 983-0177 | |
| Not Available |
| Full Name | Region Iv Area Agency On Aging, Inc |
|---|---|
| Speciality | Case Management |
| Location | 2900 Lakeview Ave, Saint Joseph, Michigan |
| Authorized Official Name and Position | Christine Vanlandingham (CEO) |
| Authorized Official Contact | 2699830177 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Region Iv Area Agency On Aging, Inc 2900 Lakeview Ave Saint Joseph MI 49085-2379 Ph: (269) 983-0177 | Region Iv Area Agency On Aging, Inc 2900 Lakeview Ave Saint Joseph MI 49085-2379 Ph: (269) 983-0177 |
| NPI Number | 1366524985 |
|---|---|
| Provider Enumeration Date | 10/20/2006 |
| Last Update Date | 07/19/2023 |
| Medicare PECOS PAC ID | 7315233905 |
|---|---|
| Medicare Enrollment ID | O20160908000217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366524985 | NPI | - | NPPES |
| 4508944 | Medicaid | MI | |
| 4509342 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
| Provider Name | Carole Anne Derucki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205809225 PECOS PAC ID: 4789609215 Enrollment ID: I20051013000200 |
| Provider Name | Carri Mccarthy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689252116 PECOS PAC ID: 2769891290 Enrollment ID: I20210512002496 |
| Provider Name | Kolleen Marie Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417670001 PECOS PAC ID: 3577939255 Enrollment ID: I20221020002305 |
| Provider Name | Melissa Powell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1457609042 PECOS PAC ID: 0547635815 Enrollment ID: I20230419001291 |
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