Healthcare Provider Details

I. General information

NPI: 1609869841
Provider Name (Legal Business Name): GOGEBIC MEDICAL CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 NORTH ST
WAKEFIELD MI
49968-9452
US

IV. Provider business mailing address

402 NORTH ST
WAKEFIELD MI
49968-9452
US

V. Phone/Fax

Practice location:
  • Phone: 906-224-9811
  • Fax: 906-224-1086
Mailing address:
  • Phone: 906-224-9811
  • Fax: 906-224-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number278510
License Number StateMI

VIII. Authorized Official

Name: MR. ROBERT E DUNN
Title or Position: ADMINISTRATOR
Credential:
Phone: 906-224-9811