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General NPI Number Information
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NPI Number | 1710362264
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Entity Type | Organization
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Legal Business Name | DOCKERTY HEALTH CARE SERVICES INC.
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 13 LONGMEADOW VILLAGE DR
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City | NILES
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State | MI
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Zip | 49120-7831
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Country | US
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Telephone | 269-683-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 8850 RED ARROW HWY
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City | BRIDGMAN
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State | MI
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Zip | 49106-9524
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Country | US
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Telephone | 269-465-7600
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Fax |
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Authorized Official
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Title or Position | OWNER/COO
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Name | TODD DOCKERTY
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Credential |
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Telephone | 269-683-7900
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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 | AH110353051
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License Number State | MI
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