Provider Demographics
NPI:1326328121
Name:MILL CREEK MEMORY CARE COMMUNITY
Entity Type:Organization
Organization Name:MILL CREEK MEMORY CARE COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:906-225-5512
Mailing Address - Street 1:1600 MILL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8877
Mailing Address - Country:US
Mailing Address - Phone:906-225-5512
Mailing Address - Fax:906-225-0988
Practice Address - Street 1:1600 MILL CREEK CT
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8877
Practice Address - Country:US
Practice Address - Phone:906-225-5512
Practice Address - Fax:906-225-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH520306235320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities