Healthcare Provider Details

I. General information

NPI: 1629187521
Provider Name (Legal Business Name): BARAGA COUNTY EXTENDED CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 SICOTTE ST
LANSE MI
49946-1243
US

IV. Provider business mailing address

832 SICOTTE ST
LANSE MI
49946-1243
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-6531
  • Fax: 906-524-7533
Mailing address:
  • Phone: 906-524-6531
  • Fax: 906-524-7533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number074010
License Number StateMI

VIII. Authorized Official

Name: TERRY MILLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 906-524-6531