NPIMap

Organization Active NPI

Manistee Benzie Community Mental Health

Doing business as Centra Wellness Network

  • Community/Behavioral Health Agency
  • Manistee, MI
National Provider Identifier
1063581205
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MANISTEE BENZIE COMMUNITY MENTAL HEALTH
Doing business as
Centra Wellness Network
Practice address
2198 US 31 S
Manistee, MI 49660-9618
Phone
(877) 398-2013
NPI assigned
Nov 6, 2006
Last updated
Jul 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donna Nieman
Title
Financial Officer
Phone
(877) 398-2013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MI Primary

Addresses

Primary practice location

2198 US 31 S
Manistee, MI 49660-9618

Mailing address

310 Glocheski Dr
Manistee, MI 49660-2639
Phone (877) 398-2013

Other practice location 1

6051 Frankfort Hwy Ste 200
Benzonia, MI 49616-9651
Phone (877) 398-2013

Other identifiers 1

IdentifierTypeStateIssuer
1705304MedicaidMI

Other names 1

  • Centra Wellness Network Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040408001362 MI Part B Supplier - Clinic/Group Practice 1850385329 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Manistee, MI; Benzonia, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

6051 Frankfort Hwy
Ste 200
Benzonia, MI 49616
Phone (231) 655-3146

395 3rd St
Manistee, MI 49660
Phone (231) 723-1506

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658448000000",
    "number": "1063581205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 GLOCHESKI DR",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496602639",
            "telephone_number": "877-398-2013",
            "fax_number": "231-723-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2198 US 31 S",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609618",
            "telephone_number": "877-398-2013"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6051 Frankfort Hwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Benzonia",
            "state": "MI",
            "postal_code": "496169651",
            "country_code": "US",
            "telephone_number": "877-398-2013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MANISTEE BENZIE COMMUNITY MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A",
        "authorized_official_last_name": "NIEMAN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "FINANCIAL OFFICER",
        "authorized_official_telephone_number": "877-398-2013"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1705304",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centra Wellness Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manistee, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.