Healthcare Provider Details

I. General information

NPI: 1659379097
Provider Name (Legal Business Name): NORTH WOODS HOME NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S CEDAR ST
MANISTIQUE MI
49854-1426
US

IV. Provider business mailing address

PO BOX 307
MANISTIQUE MI
49854-0307
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-6963
  • Fax: 906-341-2490
Mailing address:
  • Phone: 906-341-6963
  • Fax: 906-341-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number11921
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CALEB VARONI
Title or Position: ADMINISTRATOR
Credential:
Phone: 800-852-3736