MEDICARE: CLINTON AREA CARE CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	19-4040	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P80436	OTHER	MI	BLUE CARE NETWORK NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	09585	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1063419489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON AREA CARE CENTER, INC

Provider Business Mailing Address
First Line	:	1101 S SCOTT RD
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-8044
Country	:	US
Telephone Number	:	989-224-8936
Fax Number	:	989-227-8008

Provider Business Practice Location Address
First Line	:	1101 S SCOTT RD
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-8044
Country	:	US
Telephone Number	:	989-224-8936
Fax Number	:	989-227-8008

Authorized Official
Title or Position	:	CEO, LNHA
Name	:	MS. ERICA HOLMAN
Credential	:	LNHA
Telephone Number	:	989-224-8936

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	09/14/2023

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