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General NPI Number Information
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NPI Number | 1376546366
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Entity Type | Organization
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Legal Business Name | COUNTY OF BAY
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 564 W HAMPTON RD
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City | ESSEXVILLE
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State | MI
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Zip | 48732-9710
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Country | US
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Telephone | 989-892-3591
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Fax | 989-892-6991
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Provider Business Mailing Address
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Address Line | 564 W HAMPTON RD
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City | ESSEXVILLE
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State | MI
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Zip | 48732-9710
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Country | US
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Telephone | 989-892-3591
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Fax | 989-892-6991
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KYLE WEIDMAN
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Credential |
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Telephone | 989-459-1032
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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 | 098510
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License Number State | MI
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