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General NPI Number Information
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NPI Number | 1043216518
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Entity Type | Organization
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Legal Business Name | CONVALCARE CORPORATION
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 406 W MAIN ST
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City | STOCKBRIDGE
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State | MI
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Zip | 49285-9719
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Country | US
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Telephone | 517-851-7700
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Fax | 517-851-8862
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Provider Business Mailing Address
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Address Line | 406 W MAIN ST
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City | STOCKBRIDGE
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State | MI
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Zip | 49285-9719
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Country | US
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Telephone | 517-851-7700
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Fax | 517-851-8862
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. PAUL E HIMELHOCH
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Credential | L.N.H.
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Telephone | 517-851-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 334070
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License Number State | MI
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