Provider Demographics
NPI:1083607139
Name:HOUGHTON COUNTY MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:HOUGHTON COUNTY MEDICAL CARE FACILITY
Other - Org Name:CANAL VIEW HOUGHTON COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRISEBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:SENIOR BILLING SPECI
Authorized Official - Phone:906-483-2153
Mailing Address - Street 1:1100 W QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1404
Mailing Address - Country:US
Mailing Address - Phone:906-482-5050
Mailing Address - Fax:906-482-4609
Practice Address - Street 1:1100 W QUINCY ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1404
Practice Address - Country:US
Practice Address - Phone:906-482-5050
Practice Address - Fax:906-482-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI318510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2085034Medicaid
MI09620OtherBLUE CROSS
MI235031Medicare ID - Type Unspecified