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General NPI Number Information
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NPI Number | 1326328121
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Entity Type | Organization
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Legal Business Name | MILL CREEK MEMORY CARE COMMUNITY
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 1600 MILL CREEK CT
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City | MARQUETTE
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State | MI
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Zip | 49855-8877
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Country | US
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Telephone | 906-225-5512
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Fax | 906-225-0988
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Provider Business Mailing Address
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Address Line | 1600 MILL CREEK CT
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City | MARQUETTE
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State | MI
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Zip | 49855-8877
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Country | US
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Telephone | 906-225-5512
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Fax | 906-225-0988
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY MAHANEY
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Credential | RN.
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Telephone | 906-225-5512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | AH520306235
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License Number State | MI
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