Healthcare Provider Details

I. General information

NPI: 1063419489
Provider Name (Legal Business Name): CLINTON AREA CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S SCOTT RD
SAINT JOHNS MI
48879-8044
US

IV. Provider business mailing address

1101 S SCOTT RD
SAINT JOHNS MI
48879-8044
US

V. Phone/Fax

Practice location:
  • Phone: 989-224-8936
  • Fax: 989-227-8008
Mailing address:
  • Phone: 989-224-8936
  • Fax: 989-227-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number19-4040
License Number StateMI

VIII. Authorized Official

Name: MS. ERICA HOLMAN
Title or Position: CEO, LNHA
Credential: LNHA
Phone: 989-224-8936