Healthcare Provider Details

I. General information

NPI: 1285604819
Provider Name (Legal Business Name): STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 FISHER ST
MARQUETTE MI
49855
US

IV. Provider business mailing address

425 FISHER ST
MARQUETTE MI
49855-4521
US

V. Phone/Fax

Practice location:
  • Phone: 906-226-3576
  • Fax: 906-226-2380
Mailing address:
  • Phone: 906-226-3576
  • Fax: 906-226-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number52-6160
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number5301005604
License Number StateMI

VIII. Authorized Official

Name: RONALD OJA
Title or Position: ADMINISTRATOR
Credential:
Phone: 906-226-3576