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General NPI Number Information
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NPI Number | 1821218355
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Entity Type | Organization
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Legal Business Name | NORTHERN MICHIGAN RE-INTEGRATION SERVICES, INC.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 651 N OTSEGO AVE
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City | GAYLORD
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State | MI
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Zip | 49735-1531
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Country | US
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Telephone | 989-732-4550
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Fax | 989-732-2551
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Provider Business Mailing Address
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Address Line | 651 N OTSEGO AVE
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City | GAYLORD
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State | MI
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Zip | 49735-1531
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Country | US
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Telephone | 989-732-4550
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Fax | 989-732-2551
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Authorized Official
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Title or Position | OWNER
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Name | MR. KURT M WHEELER
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Credential | L.L.P., L.P.C.
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Telephone | 989-732-4550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | MI
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