1053428052 NPI number — TENDERCARE SELECT PROPERTIES INC.

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 1053428052 NPI number — TENDERCARE SELECT PROPERTIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDERCARE SELECT PROPERTIES INC.
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:
TENDERCARE GAYLORD
Provider Other Organization Name Type Code:
3
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:
1053428052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 E PORTAGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAULT SAINTE MARIE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49783-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-635-0020
Provider Business Mailing Address Fax Number:
906-635-0212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 RANDOM LN
Provider Second Line Business Practice Location Address:
RTE. 1
Provider Business Practice Location Address City Name:
GAYLORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49735-9304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-732-3508
Provider Business Practice Location Address Fax Number:
989-731-5260
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAASSEN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRIVACY OFFICER
Authorized Official Telephone Number:
414-908-8119

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  694020 , 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: 3294217 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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