Provider Demographics
NPI:1033168406
Name:NEWAYGO MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:NEWAYGO MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STILL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA, BSN, RN
Authorized Official - Phone:231-924-2020
Mailing Address - Street 1:4465 W 48TH STREET
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412
Mailing Address - Country:US
Mailing Address - Phone:231-924-2020
Mailing Address - Fax:231-924-2366
Practice Address - Street 1:4465 W 48TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-8721
Practice Address - Country:US
Practice Address - Phone:231-924-2020
Practice Address - Fax:231-924-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI628510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI612085259Medicaid
MI612085259Medicaid