Healthcare Provider Details

I. General information

NPI: 1811936768
Provider Name (Legal Business Name): GLACIER HILLS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/11/2022
Certification Date: 09/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EARHART RD
ANN ARBOR MI
48105-2768
US

IV. Provider business mailing address

1200 EARHART RD
ANN ARBOR MI
48105-2768
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-6410
  • Fax: 734-769-5958
Mailing address:
  • Phone: 734-769-6410
  • Fax: 734-769-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number814110
License Number StateMI

VIII. Authorized Official

Name: PAMELA SUE LATOVICK
Title or Position: VICE PRESIDENT REIMBURSEMENT
Credential:
Phone: 734-343-6628