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General NPI Number Information
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NPI Number | 1669553574
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Entity Type | Organization
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Legal Business Name | THE GRAND HOME OF MARSHALL
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 N GRAND ST
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City | MARSHALL
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State | MI
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Zip | 49068-1503
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Country | US
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Telephone | 269-789-1111
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Fax | 269-789-1212
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Provider Business Mailing Address
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Address Line | 111 N GRAND ST
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City | MARSHALL
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State | MI
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Zip | 49068-1503
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Country | US
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Telephone | 269-789-1111
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Fax | 269-789-1212
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. REBECCA ANN SCHOOK
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Credential | REGISTERED NURSE
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Telephone | 269-789-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 4704175126
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License Number State | MI
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