Healthcare Provider Details

I. General information

NPI: 1942248836
Provider Name (Legal Business Name): FREMONT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4554 W 48TH ST
FREMONT MI
49412-8721
US

IV. Provider business mailing address

4554 W 48TH ST
FREMONT MI
49412-8721
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-3990
  • Fax: 231-924-2881
Mailing address:
  • Phone: 231-924-3990
  • Fax: 231-924-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number624030
License Number StateMI

VIII. Authorized Official

Name: TAMI L HUNT
Title or Position: PARALEGAL
Credential:
Phone: 248-262-2357