Healthcare Provider Details

I. General information

NPI: 1861497398
Provider Name (Legal Business Name): MEADOW BROOK MEDICAL CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4543 S M 88 HWY
BELLAIRE MI
49615-9109
US

IV. Provider business mailing address

4543 S M 88 HWY
BELLAIRE MI
49615-9109
US

V. Phone/Fax

Practice location:
  • Phone: 231-533-8661
  • Fax: 231-533-4841
Mailing address:
  • Phone: 231-533-8661
  • Fax: 231-533-4841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number058510
License Number StateMI

VIII. Authorized Official

Name: MRS. JUDY MARTIN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 231-533-8661