Provider Demographics
NPI:1376535609
Name:JACKSON COUNTY MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:JACKSON COUNTY MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-782-8500
Mailing Address - Street 1:524 LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2804
Mailing Address - Country:US
Mailing Address - Phone:517-782-8500
Mailing Address - Fax:517-789-5762
Practice Address - Street 1:524 LANSING AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2804
Practice Address - Country:US
Practice Address - Phone:517-782-8500
Practice Address - Fax:517-789-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI38851314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI612085339Medicaid
MI5240260001Medicare NSC
MI612085339Medicaid