Provider Demographics
NPI:1013013275
Name:CANTERBURY HEALTH CARE, INC
Entity Type:Organization
Organization Name:CANTERBURY HEALTH CARE, INC
Other - Org Name:CANTERBURY ON-THE-LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRUTCHAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-674-9292
Mailing Address - Street 1:5601 HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3451
Mailing Address - Country:US
Mailing Address - Phone:248-674-9292
Mailing Address - Fax:248-674-5393
Practice Address - Street 1:5601 HATCHERY RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329
Practice Address - Country:US
Practice Address - Phone:248-674-9292
Practice Address - Fax:248-674-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1070000051314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI60 2083058Medicaid
09755OtherBLUE CROSS/ BLUE SHIELD M
F0000008663OtherBLUE CARE NETWORK