Healthcare Provider Details

I. General information

NPI: 1609784784
Provider Name (Legal Business Name): BUCHANAN AL OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CAROLL ST
BUCHANAN MI
49107-1738
US

IV. Provider business mailing address

111 W FERRY ST
BERRIEN SPRINGS MI
49103-1154
US

V. Phone/Fax

Practice location:
  • Phone: 574-261-1124
  • Fax:
Mailing address:
  • Phone: 574-261-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TODD DOCKERTY
Title or Position: COO
Credential:
Phone: 574-261-1124