Healthcare Provider Details

I. General information

NPI: 1730282237
Provider Name (Legal Business Name): BARAGA COUNTY MEMORIAL HOSPITAL LTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 N MAIN ST
LANSE MI
49946-1126
US

IV. Provider business mailing address

770 N MAIN ST
LANSE MI
49946-1126
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-3300
  • Fax: 906-524-5466
Mailing address:
  • Phone: 906-524-3300
  • Fax: 906-524-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number073010
License Number StateMI

VIII. Authorized Official

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