Healthcare Provider Details

I. General information

NPI: 1588655849
Provider Name (Legal Business Name): FERGUSON CONVALESCENT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S MAIN ST
LAPEER MI
48446-2426
US

IV. Provider business mailing address

239 S MAIN ST
LAPEER MI
48446-2426
US

V. Phone/Fax

Practice location:
  • Phone: 810-664-6611
  • Fax: 810-664-8633
Mailing address:
  • Phone: 810-664-6611
  • Fax: 810-664-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number44-4010
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number44-4010
License Number StateMI

VIII. Authorized Official

Name: MRS. ANNA LEE FERGUSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 810-664-6611