Healthcare Provider Details

I. General information

NPI: 1649304270
Provider Name (Legal Business Name): GRAND TRAVERSE PAVILIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PAVILIONS CIRCLE
TRAVERSE CITY MI
49684
US

IV. Provider business mailing address

1000 PAVILIONS CIRCLE
TRAVERSE CITY MI
49684
US

V. Phone/Fax

Practice location:
  • Phone: 231-932-3000
  • Fax:
Mailing address:
  • Phone: 231-932-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY BALL
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 231-932-3063