Healthcare Provider Details

I. General information

NPI: 1487767026
Provider Name (Legal Business Name): MIDMICHIGAN STRATFORD VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ROCKWELL DRIVE
MIDLAND MI
48642-9316
US

IV. Provider business mailing address

2121 ROCKWELL DRIVE
MIDLAND MI
48642-9316
US

V. Phone/Fax

Practice location:
  • Phone: 989-633-5350
  • Fax:
Mailing address:
  • Phone: 989-633-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number564011
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1070000265
License Number StateMI

VIII. Authorized Official

Name: JAN WRZESINSKI
Title or Position: PATIENT ACCOUNTING MANAGER
Credential:
Phone: 989-633-1486