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General NPI Number Information
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NPI Number | 1376545533
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Entity Type | Organization
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Legal Business Name | MICHIGAN MASONIC HOME
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 1200 WRIGHT AVE
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City | ALMA
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State | MI
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Zip | 48801-1133
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Country | US
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Telephone | 989-463-3141
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Fax | 989-466-2796
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Provider Business Mailing Address
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Address Line | 1200 WRIGHT AVE
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City | ALMA
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State | MI
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Zip | 48801-1133
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Country | US
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Telephone | 989-463-3141
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Fax | 989-466-2796
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY MAPES
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Credential | PRESIDENT, HOME BOAR
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Telephone | 989-463-4285
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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 | 294040
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License Number State | MI
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