Healthcare Provider Details

I. General information

NPI: 1376763896
Provider Name (Legal Business Name): STAFF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

105F STONEBROOK PL # 417
JACKSON TN
38305-3636
US

V. Phone/Fax

Practice location:
  • Phone: 606-964-4200
  • Fax:
Mailing address:
  • Phone: 773-640-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. YVETTE M. GEORGE
Title or Position: STAFF CRNA
Credential: CRNA
Phone: 773-640-6853