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General NPI Number Information
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NPI Number | 1174907380
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Entity Type | Organization
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Legal Business Name | CHERRY BLOSSOM MANOR, INC.
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 611 E MAIN ST SUITE B
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City | HART
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State | MI
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Zip | 49420-1190
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Country | US
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Telephone | 231-873-5377
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Fax | 231-873-7108
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Provider Business Mailing Address
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Address Line | PO BOX 332
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City | HART
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State | MI
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Zip | 49420-0332
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Country | US
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Telephone | 231-873-5377
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Fax | 231-873-7108
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA ANN HINDMAN
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Credential |
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Telephone | 231-873-5377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AH640236763
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License Number State | MI
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