Healthcare Provider Details

I. General information

NPI: 1477083442
Provider Name (Legal Business Name): MENOMINEE CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 2ND ST
MENOMINEE MI
49858-3203
US

IV. Provider business mailing address

1120 ALPS RD
WAYNE NJ
07470-3704
US

V. Phone/Fax

Practice location:
  • Phone: 906-863-9941
  • Fax: 906-853-9942
Mailing address:
  • Phone: 201-953-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: GREGORY HOOK
Title or Position: OFFICER
Credential:
Phone: 201-953-0546