Provider Demographics
NPI:1124026224
Name:LITCHFIELD NURSING CENTRE, INC.
Entity Type:Organization
Organization Name:LITCHFIELD NURSING CENTRE, INC.
Other - Org Name:LITCHFIELD NURSING CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BANDSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-799-6870
Mailing Address - Street 1:5000 HAKES DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5574
Mailing Address - Country:US
Mailing Address - Phone:231-799-6870
Mailing Address - Fax:231-799-0250
Practice Address - Street 1:527 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MI
Practice Address - Zip Code:49252-9145
Practice Address - Country:US
Practice Address - Phone:517-542-2323
Practice Address - Fax:517-542-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI30-4010314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09774OtherBCBS PROVIDER CODE
MI23-5505Medicare ID - Type Unspecified