Healthcare Provider Details

I. General information

NPI: 1518342062
Provider Name (Legal Business Name): DOCKERTY HEALTH CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6786 RED ARROW HWY
COLOMA MI
49038-9703
US

IV. Provider business mailing address

8850 RED ARROW HWY
BRIDGMAN MI
49106-9524
US

V. Phone/Fax

Practice location:
  • Phone: 269-468-5800
  • Fax:
Mailing address:
  • Phone: 269-465-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL110341658
License Number StateMI

VIII. Authorized Official

Name: TODD DOCKERTY
Title or Position: OWNER/COO
Credential:
Phone: 269-458-5800