1306014477 NPI number — TENDERCARE MICHIGAN, INC.

Table of content: (NPI 1306014477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306014477 NPI number — TENDERCARE MICHIGAN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDERCARE MICHIGAN, 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:
ROGERS CITY REHABILITATION HOSPITAL
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:
1306014477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 N BRADLEY HWY
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ROGERS CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49779-1539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-734-7575
Provider Business Mailing Address Fax Number:
989-734-7648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 N BRADLEY HWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ROGERS CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49779-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-734-7575
Provider Business Practice Location Address Fax Number:
989-734-7648
Provider Enumeration Date:
02/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PAVEY
Authorized Official First Name:
JOYAL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEUTIVE DIRECTOR
Authorized Official Telephone Number:
989-734-7948

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  710030 , 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: 303205745 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00255 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 70-0-G1-1010-0 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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