Healthcare Provider Details

I. General information

NPI: 1710972344
Provider Name (Legal Business Name): OUR LADY OF MERCY CONVALESCENT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/08/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52225 B AVE
HUBBELL MI
49934-9719
US

IV. Provider business mailing address

52225 B AVE. P.O. BOX 369
HUBBELL MI
49934-0369
US

V. Phone/Fax

Practice location:
  • Phone: 906-296-3301
  • Fax: 906-296-0779
Mailing address:
  • Phone: 906-296-3301
  • Fax: 906-296-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314010
License Number StateMI

VIII. Authorized Official

Name: BENJAMIN T. FRIEDMAN
Title or Position: PRESIDENT
Credential:
Phone: 773-810-9450