Provider Demographics
NPI:1386196806
Name:MICHELLE HANSON
Entity Type:Organization
Organization Name:MICHELLE HANSON
Other - Org Name:SUGARLOAF MANOR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-323-9745
Mailing Address - Street 1:807 WITTERS CT
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-6116
Mailing Address - Country:US
Mailing Address - Phone:269-323-9745
Mailing Address - Fax:
Practice Address - Street 1:807 WITTERS CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-6116
Practice Address - Country:US
Practice Address - Phone:269-323-9745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF390379270311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home