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General NPI Number Information
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NPI Number | 1487930145
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Entity Type | Organization
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Legal Business Name | PARKSIDE OF NORTHPORT
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 215 S HIGH ST
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City | NORTHPORT
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State | MI
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Zip | 49670-9807
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Country | US
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Telephone | 231-386-9900
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Fax | 231-386-5146
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Provider Business Mailing Address
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Address Line | 215 S. HIGH STREET
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City | NORTHPORT
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State | MI
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Zip | 49670
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Country | US
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Telephone | 231-386-9900
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Fax | 231-386-5146
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Authorized Official
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Title or Position | DIRECTOR OF RESIDENT SERVICES
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Name | MS. KATHRYN ANN BROWNING
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Credential |
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Telephone | 231-386-9900
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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 | AH450293385
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License Number State | MI
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