Molina Healthcare of Michigan Long Term Services & Supports Survey

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.
1.LTSS Group NPI(Required.)
2.LTSS Practice Name(Required.)
3.Full Address(Required.)
4.Phone Number(Required.)
5.Name of Person Completing Survey(Required.)
6.Select the counties you currently provide services in(Required.)
7.Select the services you currently provide(Required.)
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.
9.Do you have multiple office locations and/or satellite offices.(Required.)
Thank you for taking the time to complete the Molina Healthcare of Michigan LTSS Survey