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General NPI Number Information
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NPI Number | 1124026224
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Entity Type | Organization
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Legal Business Name | LITCHFIELD NURSING CENTRE, INC.
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 527 MARSHALL ST
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City | LITCHFIELD
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State | MI
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Zip | 49252-9145
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Country | US
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Telephone | 517-542-2323
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Fax | 517-542-3032
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Provider Business Mailing Address
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Address Line | 5000 HAKES DR SUITE 600
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City | NORTON SHORES
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State | MI
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Zip | 49441-5574
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Country | US
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Telephone | 231-799-6870
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Fax | 231-799-0250
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN GEORGE BANDSTRA
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Credential |
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Telephone | 231-799-6870
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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 | 30-4010
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License Number State | MI
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