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General NPI Number Information
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NPI Number | 1326025776
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Entity Type | Organization
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Legal Business Name | DEBOER, INC.
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 1684 VULCAN ST
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City | MUSKEGON
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State | MI
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Zip | 49442-6070
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Country | US
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Telephone | 231-777-2511
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Fax | 231-777-4500
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Provider Business Mailing Address
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Address Line | 1750 VULCAN ST
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City | MUSKEGON
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State | MI
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Zip | 49442-6048
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Country | US
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Telephone | 231-777-2511
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Fax | 231-777-4500
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CONNI MCGLYNN
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Credential |
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Telephone | 231-777-2511
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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 | AH610236808
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 614020
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License Number State | MI
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