Healthcare Provider Details

I. General information

NPI: 1548214315
Provider Name (Legal Business Name): KEWEENAW HOME NURSING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 6TH ST
CALUMET MI
49913-1507
US

IV. Provider business mailing address

311 6TH ST
CALUMET MI
49913-1507
US

V. Phone/Fax

Practice location:
  • Phone: 906-337-5700
  • Fax: 906-337-9929
Mailing address:
  • Phone: 906-337-5700
  • Fax: 906-337-9929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number14333
License Number StateMI

VIII. Authorized Official

Name: WANDA M KOLB
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 906-337-5700