Healthcare Provider Details

I. General information

NPI: 1306958491
Provider Name (Legal Business Name): PORTAGE HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CAMPUS DR
HANCOCK MI
49930-1569
US

IV. Provider business mailing address

520 CAMPUS DR
HANCOCK MI
49930-1569
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1000
  • Fax:
Mailing address:
  • Phone: 906-483-1000
  • 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: MR. JAMES BOGAN
Title or Position: CEO
Credential:
Phone: 906-483-1501