Healthcare Provider Details

I. General information

NPI: 1396724332
Provider Name (Legal Business Name): IRON RIVER CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LINCOLN AVE
IRON RIVER MI
49935-8452
US

IV. Provider business mailing address

330 LINCOLN AVE
IRON RIVER MI
49935-8452
US

V. Phone/Fax

Practice location:
  • Phone: 906-265-5168
  • Fax: 906-265-5571
Mailing address:
  • Phone: 906-265-5168
  • Fax: 906-265-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number364040
License Number StateMI

VIII. Authorized Official

Name: MR. ROBERT W POSSANZA JR.
Title or Position: PRESIDENT
Credential: NHA
Phone: 906-265-5168