Healthcare Provider Details

I. General information

NPI: 1760652853
Provider Name (Legal Business Name): DOUGLAS INVESTMENTS & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 WILEY RD
DOUGLAS MI
49406-5108
US

IV. Provider business mailing address

PO BOX 217
DOUGLAS MI
49406-0217
US

V. Phone/Fax

Practice location:
  • Phone: 269-857-2141
  • Fax: 269-857-1802
Mailing address:
  • Phone: 269-857-2141
  • Fax: 269-857-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number034011
License Number StateMI

VIII. Authorized Official

Name: MR. CRAIG D. TAYLOR
Title or Position: CHIEF MANAGER
Credential:
Phone: 423-308-1845