Healthcare Provider Details

I. General information

NPI: 1033168406
Provider Name (Legal Business Name): NEWAYGO MEDICAL CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 W 48TH ST
FREMONT MI
49412-8721
US

IV. Provider business mailing address

4465 W 48TH STREET
FREMONT MI
49412
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-2020
  • Fax: 231-924-2366
Mailing address:
  • Phone: 231-924-2020
  • Fax: 231-924-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number628510
License Number StateMI

VIII. Authorized Official

Name: MS. JUDITH ANN STILL
Title or Position: ADMINISTRATOR
Credential: LNHA, BSN, RN
Phone: 231-924-2020