1265719116 NPI number — MORRELL'S FAMILY HOME

Table of content: (NPI 1265719116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265719116 NPI number — MORRELL'S FAMILY HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRELL'S FAMILY HOME
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:
Provider Other Organization Name Type Code:
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:
1265719116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 110TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTIN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49070-9721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-692-2400
Provider Business Mailing Address Fax Number:
269-692-6020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 110TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTIN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49070-9721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-692-2400
Provider Business Practice Location Address Fax Number:
269-692-6020
Provider Enumeration Date:
11/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PILLARS
Authorized Official First Name:
GLENDA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER OPERATOR
Authorized Official Telephone Number:
269-692-2400

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , with the licence number:  AF030293174 , 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)