1336507110 NPI number — STRATFORD PINES OPERATING, LLC

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 1336507110 NPI number — STRATFORD PINES OPERATING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATFORD PINES OPERATING, LLC
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:
STRATFORD PINES NURSING AND REHABILITATION CENTER
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:
1336507110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2532 W CADILLAC DR
Provider Second Line Business Mailing Address:
PO BOX 579
Provider Business Mailing Address City Name:
FARWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48622-9757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-588-3547
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 ROCKWELL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48642-9316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-588-3547
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
DOYLE
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
989-588-3547

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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)





Copyright © 2007-2024 www.npivalidator.com