1932256856 NPI number — BRANCH COUNTY TREASURER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932256856 NPI number — BRANCH COUNTY TREASURER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANCH COUNTY TREASURER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MAPLE LAWN MEDICAL CARE FACILITY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932256856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 SANDERSON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLDWATER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49036-2228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-279-9587
Provider Business Mailing Address Fax Number:
517-279-8304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 SANDERSON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49036-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-279-9587
Provider Business Practice Location Address Fax Number:
517-279-8304
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SABAITIS
Authorized Official First Name:
JAYNE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
517-279-9587

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  128511 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09636 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2085016 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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