Healthcare Provider Details

I. General information

NPI: 1356348114
Provider Name (Legal Business Name): SCHOOLCRAFT MEDICAL CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MAIN ST
MANISTIQUE MI
49854-1522
US

IV. Provider business mailing address

520 MAIN ST
MANISTIQUE MI
49854-1522
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-6921
  • Fax: 906-341-6213
Mailing address:
  • Phone: 906-341-6921
  • Fax: 906-341-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number778510
License Number StateMI

VIII. Authorized Official

Name: TONYA SUE LEIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 906-341-6921