Healthcare Provider Details

I. General information

NPI: 1154366086
Provider Name (Legal Business Name): TENDERCARE (MICHIGAN) INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E PROVINCIAL HOUSE DR
LANSING MI
48910-4884
US

IV. Provider business mailing address

209 E PORTAGE AVE
SAULT SAINTE MARIE MI
49783-4200
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-2458
  • Fax: 517-882-2950
Mailing address:
  • Phone: 906-635-0020
  • Fax: 906-635-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number334150
License Number StateMI

VIII. Authorized Official

Name: MR. DOUGLAS J. WELTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 906-635-0020