Provider Demographics
NPI:1336466929
Name:MAGNUM HEALTH AND REHAB OF ADRIAN LLC
Entity Type:Organization
Organization Name:MAGNUM HEALTH AND REHAB OF ADRIAN LLC
Other - Org Name:MAGNUM CARE OF ADRIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-265-6554
Mailing Address - Street 1:130 SAND CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-9129
Mailing Address - Country:US
Mailing Address - Phone:517-265-6554
Mailing Address - Fax:517-263-0657
Practice Address - Street 1:130 SAND CREEK HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-9129
Practice Address - Country:US
Practice Address - Phone:517-265-6554
Practice Address - Fax:517-263-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-5504OtherMEDICARE PROVIDER NUMBER