Healthcare Provider Details

I. General information

NPI: 1083605802
Provider Name (Legal Business Name): EAST LANSING HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 NORTHWIND DR
EAST LANSING MI
48823-5003
US

IV. Provider business mailing address

2815 NORTHWIND DR
EAST LANSING MI
48823-5003
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-0817
  • Fax:
Mailing address:
  • Phone: 517-332-0817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number334060
License Number StateMI

VIII. Authorized Official

Name: MR. CHAUNCEY R. DUNBAR
Title or Position: SECRETARY / TREASURER
Credential: CPA
Phone: 601-956-1576