Healthcare Provider Details

I. General information

NPI: 1689612590
Provider Name (Legal Business Name): MATHER HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 STONEVILLE RD
ISHPEMING MI
49849-2921
US

IV. Provider business mailing address

435 STONEVILLE RD
ISHPEMING MI
49849-2921
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-1073
  • Fax: 906-485-4611
Mailing address:
  • Phone: 906-485-1073
  • Fax: 906-485-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number524050
License Number StateMI

VIII. Authorized Official

Name: AARON MAUER
Title or Position: CFO
Credential:
Phone: 847-902-9586