Healthcare Provider Details

I. General information

NPI: 1164623385
Provider Name (Legal Business Name): DOCKERTY HEALTH CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 RED ARROW HWY
BRIDGMAN MI
49106
US

IV. Provider business mailing address

8850 RED ARROW HWY PO BOX 370
BRIDGMAN MI
49106
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-7600
  • Fax: 269-465-6463
Mailing address:
  • Phone: 269-465-7600
  • Fax: 269-465-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: TIMOTHY MARK DOCKERTY
Title or Position: DIRECTOR
Credential:
Phone: 269-465-7600