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NPI Code Detail

MEDICARE: COUNTY OF GRAND TRAVERSE

MEDICARE: COUNTY OF GRAND TRAVERSE
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
1314000000XSkilled Nursing Facility288510MI

Other Identifiers

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

General Provider Information

NPI Number : 1326124322
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF GRAND TRAVERSE
Provider Business Mailing Address
First Line : 1000 PAVILIONS CIRCLE
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-3198
Country : US
Telephone Number : 231-932-3000
Fax Number : 231-932-3009
Provider Business Practice Location Address
First Line : 1000 PAVILIONS CIRCLE
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-3198
Country : US
Telephone Number : 231-932-3000
Fax Number : 231-932-3009
Authorized Official
Title or Position : CEO/ADMINISTRATOR
Name : MR. KORVYN R HANSEN JR.
Credential :
Telephone Number : 231-932-3010
Provider Enumeration Date : 10/31/2006
Last Update Date : 11/14/2016

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Directions to “COUNTY OF GRAND TRAVERSE ” Practice Location

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