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General NPI Number Information
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NPI Number | 1841006855
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Entity Type | Individual
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Provider Name | ROBERTA JO HARTUNG
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Gender | Female
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1493 N COCHRAN AVE
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City | CHARLOTTE
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State | MI
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Zip | 48813-9702
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Country | US
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Telephone | 517-543-9626
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Fax | 517-543-3764
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Provider Business Mailing Address
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Address Line | 10709 VANWERT RD
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City | HOMER
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State | MI
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Zip | 49245-9308
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Country | US
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Telephone | 517-667-2559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS230418724
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License Number State | MI
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