Healthcare Provider Details

I. General information

NPI: 1457459059
Provider Name (Legal Business Name): BARAGA COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MEMORIAL ST SUITE A
LANSE MI
49946-1138
US

IV. Provider business mailing address

510 MEMORIAL ST SUITE A
LANSE MI
49946-1138
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-4663
  • Fax: 906-524-5663
Mailing address:
  • Phone: 906-524-4663
  • Fax: 906-524-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number073512
License Number StateMI

VIII. Authorized Official

Name: JOHN P TEMBREULL JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 906-524-3321