Provider Demographics
NPI:1184817231
Name:NYFRIES, INC
Entity Type:Organization
Organization Name:NYFRIES, INC
Other - Org Name:UP HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN,CHPN
Authorized Official - Phone:906-225-4545
Mailing Address - Street 1:1125 W RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3191
Mailing Address - Country:US
Mailing Address - Phone:906-225-4545
Mailing Address - Fax:906-225-7573
Practice Address - Street 1:1125 W RIDGE ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-4545
Practice Address - Fax:906-225-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI523515251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2932595Medicaid
MI08743OtherBCBS HOSPICE
MI2932595Medicaid