MEDICARE: RAI CARE CENTERS OF MICHIGAN II, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08951	OTHER	MI	BCBS
2	09467	OTHER	MI	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336232917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAI CARE CENTERS OF MICHIGAN II, LLC

Provider Business Mailing Address
First Line	:	1080 W NORTON AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-4108
Country	:	US
Telephone Number	:	231-780-5468
Fax Number	:	231-780-5410

Provider Business Practice Location Address
First Line	:	1080 W NORTON AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-4108
Country	:	US
Telephone Number	:	231-780-5468
Fax Number	:	231-780-5410

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BARRY L. BLANTON
Credential	:
Telephone Number	:	781-699-9000

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/17/2023

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