Healthcare Provider Details

I. General information

NPI: 1659344844
Provider Name (Legal Business Name): BURCHAM HILLS RETIREMENT CENTER II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BURCHAM DR
EAST LANSING MI
48823-3898
US

IV. Provider business mailing address

2700 BURCHAM DR
EAST LANSING MI
48823-3898
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-8377
  • Fax: 517-336-1916
Mailing address:
  • Phone: 517-351-8377
  • Fax: 517-336-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number339030
License Number StateMI

VIII. Authorized Official

Name: JAMES C KACZMARCZYK JR.
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 517-351-4662