MEDICARE: NICHE AGING CENTER

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	AS090309821	MI

General Provider Information

NPI Number	:	1689004921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHE AGING CENTER

Provider Business Mailing Address
First Line	:	3405 E MIDLAND RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2825
Country	:	US
Telephone Number	:	989-684-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 E MIDLAND RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2825
Country	:	US
Telephone Number	:	989-684-2273
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE/OWNER
Name	:	MRS. GINGER ELIZABETH NAHIKIAN
Credential	:	RN
Telephone Number	:	989-684-2273

Provider Enumeration Date	:	11/23/2013
Last Update Date	:	11/23/2013

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