=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417942103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEPLINSKI INVESTMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1395 S HURON RD
-----------------------------------------------------
City | KAWKAWLIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48631-9485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-684-3210
-----------------------------------------------------
Fax | 989-684-6909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1395 S HURON RD
-----------------------------------------------------
City | KAWKAWLIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48631-9485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-684-3210
-----------------------------------------------------
Fax | 989-684-6909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. JEFFERY SCHADE
-----------------------------------------------------
Credential | NHA
-----------------------------------------------------
Telephone | 989-684-3210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 094030
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------