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General NPI Number Information
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NPI Number | 1629390943
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Entity Type | Organization
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Legal Business Name | MARQUETTE ADULT DAY SERVICES
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 120 N FRONT ST
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City | MARQUETTE
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State | MI
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Zip | 49855-4337
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Country | US
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Telephone | 906-226-2142
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Fax |
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Provider Business Mailing Address
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Address Line | 120 N FRONT ST
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City | MARQUETTE
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State | MI
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Zip | 49855-4337
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Country | US
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Telephone | 906-226-2142
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AMY MATTSON
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Credential |
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Telephone | 906-226-2142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | MI
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