Healthcare Provider Details

I. General information

NPI: 1497796395
Provider Name (Legal Business Name): TENDERCARE (MICHIGAN) INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S HURON ST
CHEBOYGAN MI
49721-2210
US

IV. Provider business mailing address

111 W MICHIGAN ST
MILWAUKEE WI
53203-2903
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-4347
  • Fax: 231-627-4883
Mailing address:
  • Phone: 414-908-8119
  • Fax: 414-908-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number164010
License Number StateMI

VIII. Authorized Official

Name: MS. DONNA JO MAASSEN
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 414-908-8119