Provider Demographics
NPI:1306014477
Name:TENDERCARE MICHIGAN, INC.
Entity Type:Organization
Organization Name:TENDERCARE MICHIGAN, INC.
Other - Org Name:ROGERS CITY REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-734-7948
Mailing Address - Street 1:555 N BRADLEY HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1539
Mailing Address - Country:US
Mailing Address - Phone:989-734-7575
Mailing Address - Fax:989-734-7648
Practice Address - Street 1:555 N BRADLEY HWY
Practice Address - Street 2:SUITE C
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-1539
Practice Address - Country:US
Practice Address - Phone:989-734-7575
Practice Address - Fax:989-734-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI710030208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI303205745Medicaid
MI00255OtherBLUE CROSS BLUE SHIELD
MI70-0-G1-1010-0OtherBLUE CROSS BLUE SHIELD
MI303205745Medicaid
MIMI13768Medicare PIN