Healthcare Provider Details

I. General information

NPI: 1245453786
Provider Name (Legal Business Name): PORTAGE HEALTH HOME SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MICHIGAN ST STE 328
HANCOCK MI
49930-1448
US

IV. Provider business mailing address

200 MICHIGAN ST STE 328
HANCOCK MI
49930-1448
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1170
  • Fax: 906-487-7487
Mailing address:
  • Phone: 906-483-1170
  • Fax: 906-487-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES BOGAN
Title or Position: BOARD PRESIDENT
Credential:
Phone: 906-483-1170