Healthcare Provider Details

I. General information

NPI: 1043216518
Provider Name (Legal Business Name): CONVALCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W MAIN ST
STOCKBRIDGE MI
49285-9719
US

IV. Provider business mailing address

406 W MAIN ST
STOCKBRIDGE MI
49285-9719
US

V. Phone/Fax

Practice location:
  • Phone: 517-851-7700
  • Fax: 517-851-8862
Mailing address:
  • Phone: 517-851-7700
  • Fax: 517-851-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number334070
License Number StateMI

VIII. Authorized Official

Name: MR. PAUL E HIMELHOCH
Title or Position: ADMINISTRATOR
Credential: L.N.H.
Phone: 517-851-7700