Healthcare Provider Details

I. General information

NPI: 1083610984
Provider Name (Legal Business Name): MANISTEE COUNTY MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 E PARKDALE AVE
MANISTEE MI
49660-9319
US

IV. Provider business mailing address

1505 E PARKDALE AVE
MANISTEE MI
49660-9319
US

V. Phone/Fax

Practice location:
  • Phone: 231-723-2543
  • Fax: 231-723-1773
Mailing address:
  • Phone: 231-723-2543
  • Fax: 231-723-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number518510
License Number StateMI

VIII. Authorized Official

Name: MRS. LINDA DUCHON
Title or Position: ADMINISTRATOR
Credential: R.N., LNHA
Phone: 231-723-2543