MEDICARE: SANILAC COUNTY

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	768510	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194722165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANILAC COUNTY

Provider Business Mailing Address
First Line	:	137 N ELK ST
Second Line	:
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1129
Country	:	US
Telephone Number	:	810-648-3017
Fax Number	:	810-648-4912

Provider Business Practice Location Address
First Line	:	137 N ELK ST
Second Line	:
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1129
Country	:	US
Telephone Number	:	810-648-3017
Fax Number	:	810-648-4912

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. KIM K KLIDA
Credential	:
Telephone Number	:	810-648-3017

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/25/2018

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Practice Location Address:

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Practice Location Address:

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Directions to “SANILAC COUNTY ” Practice Location

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