Healthcare Provider Details

I. General information

NPI: 1770404089
Provider Name (Legal Business Name): KERAK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14077 STONE JUG RD
BATTLE CREEK MI
49015-8623
US

IV. Provider business mailing address

14077 STONE JUG RD
BATTLE CREEK MI
49015-8623
US

V. Phone/Fax

Practice location:
  • Phone: 269-719-2812
  • Fax: 269-282-0095
Mailing address:
  • Phone: 269-719-2812
  • Fax: 269-282-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JILL M LONG
Title or Position: OWNER
Credential:
Phone: 931-217-7606