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General NPI Number Information
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NPI Number | 1235208182
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Entity Type | Organization
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Legal Business Name | STATE OF MICHIGAN
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 1400 W PICKARD ST
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City | MT PLEASANT
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State | MI
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Zip | 48858-1364
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Country | US
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Telephone | 989-773-7921
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 30437
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City | LANSING
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State | MI
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Zip | 48909-7937
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Country | US
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Telephone | 517-335-8245
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Fax | 517-335-6995
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Authorized Official
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Title or Position | DIRECTOR OF HOSPITAL - CNETERS
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Name | CYNTHIA KELLY
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Credential |
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Telephone | 517-335-0263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5301001112
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | 5301001112
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License Number State | MI
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