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Thank you for being a valued Molina Healthcare of Michigan Home and Community Based Services Provider. Molina is working to update our records and want to ensure your servicing area is accurate captured.

Please take a couple of minutes to fill out this survey.

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* 1. LTSS Group NPI

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* 2. LTSS Practice Name

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* 3. Full Address

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* 4. Phone Number

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* 5. Name of Person Completing Survey

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* 6. Select the counties you currently provide services in

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* 7. Select the services you currently provide

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* 8. Are you willing to expand your service offering and/or the counties that you serve. If yes, please share your expansion interest in the comment box below.

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* 9. Do you have multiple office locations and/or satellite offices.

Thank you for taking the time to complete the Molina Healthcare of Michigan LTSS Survey

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