Provider Demographics
NPI:1417181173
Name:ASPIRUS KEWEENAW HOME HEALTH & HOSPICE
Entity Type:Organization
Organization Name:ASPIRUS KEWEENAW HOME HEALTH & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT EXTENDED SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2600
Mailing Address - Street 1:311 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CALUMET
Mailing Address - State:MI
Mailing Address - Zip Code:49913-1507
Mailing Address - Country:US
Mailing Address - Phone:906-337-5700
Mailing Address - Fax:906-337-9929
Practice Address - Street 1:311 6TH ST
Practice Address - Street 2:
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-1507
Practice Address - Country:US
Practice Address - Phone:906-337-5700
Practice Address - Fax:906-337-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237212Medicare PIN