1083658371 NPI number — TENDERCARE TAWAS CITY INC.

Table of content: (NPI 1083658371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083658371 NPI number — TENDERCARE TAWAS CITY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDERCARE TAWAS CITY 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 TAWAS CITY
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:
1083658371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 W MICHIGAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53203-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-908-8119
Provider Business Mailing Address Fax Number:
414-908-8481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 WEST NORTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAWAS CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48763-9161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-362-8645
Provider Business Practice Location Address Fax Number:
989-362-4462
Provider Enumeration Date:
06/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAASSEN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
DIRECTOR OF COMPLIANCE
Authorized Official Telephone Number:
414-908-8119

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  354010 , 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)