Provider Demographics
NPI:1124025440
Name:EMMET COUNTY MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:EMMET COUNTY MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSITRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-526-4400
Mailing Address - Street 1:750 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-1548
Mailing Address - Country:US
Mailing Address - Phone:231-526-4403
Mailing Address - Fax:231-526-5252
Practice Address - Street 1:750 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-1548
Practice Address - Country:US
Practice Address - Phone:231-526-4403
Practice Address - Fax:231-526-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI248510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09615OtherBCBSM
MI09615OtherMEDICARE ADVANTAGE
MI5189702Medicaid
MI09615OtherBCBSM