NPIMap

Organization Active NPI

Manistee Benzie Community Mental Health

Doing business as Centra Wellness Network

  • Primary Care Clinic/Center
  • Manistee, MI
National Provider Identifier
1366806432
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
MANISTEE BENZIE COMMUNITY MENTAL HEALTH
Doing business as
Centra Wellness Network
Practice address
310 Glocheski Dr
Manistee, MI 49660-2639
Phone
(877) 398-2013
Fax
(231) 723-1504
NPI assigned
Apr 5, 2016
Last updated
Jul 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Authorized official

Name
Ms. Donna J Nieman
Title
Chief Finance Officer
Phone
(877) 398-2013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

310 Glocheski Dr
Manistee, MI 49660-2639

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 (887) 398-2013

Other practice location 2

2198 US 31 S
Manistee, MI 49660-9618
Phone (887) 398-2013

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
This NPI is an additional NPI on the 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

310 Glocheski Dr
Manistee, MI 49660
Phone (231) 309-1719

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688601600000",
    "number": "1366806432",
    "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": "310 GLOCHESKI DR",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496602639",
            "telephone_number": "877-398-2013",
            "fax_number": "231-723-1504"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6051 Frankfort Hwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Benzonia",
            "state": "MI",
            "postal_code": "496169651",
            "country_code": "US",
            "telephone_number": "887-398-2013",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2198 US 31 S",
            "address_purpose": "LOCATION",
            "city": "Manistee",
            "state": "MI",
            "postal_code": "496609618",
            "country_code": "US",
            "telephone_number": "887-398-2013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MANISTEE BENZIE COMMUNITY MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-05",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "NIEMAN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCE OFFICER",
        "authorized_official_telephone_number": "877-398-2013",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centra Wellness Network",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "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 6, 2023; 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.