Healthcare Provider Details

I. General information

NPI: 1336507110
Provider Name (Legal Business Name): STRATFORD PINES OPERATING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ROCKWELL DR
MIDLAND MI
48642-9316
US

IV. Provider business mailing address

2532 W CADILLAC DR PO BOX 579
FARWELL MI
48622-9757
US

V. Phone/Fax

Practice location:
  • Phone: 989-588-3547
  • Fax:
Mailing address:
  • Phone: 989-588-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRIAN DOYLE THOMPSON
Title or Position: TREASURER
Credential:
Phone: 989-588-3547