Healthcare Provider Details

I. General information

NPI: 1457761132
Provider Name (Legal Business Name): DANSVILLE COUNTRY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 E COLUMBIA ST
MASON MI
48854-1345
US

IV. Provider business mailing address

776 E COLUMBIA ST
MASON MI
48854-1345
US

V. Phone/Fax

Practice location:
  • Phone: 517-883-5028
  • Fax: 517-883-5028
Mailing address:
  • Phone: 517-883-5028
  • Fax: 517-883-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAS330336343
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAS330316950
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAS330336343
License Number StateMI

VIII. Authorized Official

Name: ROXANNE NORTON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 517-883-5028