Healthcare Provider Details

I. General information

NPI: 1720484504
Provider Name (Legal Business Name): MUNSON HEALTHCARE GRAYLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE
GRAYLING MI
49738-1312
US

IV. Provider business mailing address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2349
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-0594
  • Fax:
Mailing address:
  • Phone: 231-935-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KORTH-WHITE KIRSTEN
Title or Position: PRESIDENT/CEO EAST REGION
Credential:
Phone: 989-348-0720