Provider Demographics
NPI:1083605802
Name:EAST LANSING HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:EAST LANSING HEALTH CARE CENTER, INC.
Other - Org Name:EAST LANSING HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:601-956-1576
Mailing Address - Street 1:2815 NORTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5003
Mailing Address - Country:US
Mailing Address - Phone:517-332-0817
Mailing Address - Fax:
Practice Address - Street 1:2815 NORTHWIND DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5003
Practice Address - Country:US
Practice Address - Phone:517-332-0817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI334060314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1578776Medicaid
235517Medicare Oscar/Certification
MI1198070001Medicare NSC