Provider Demographics
NPI:1417931858
Name:MAPLES-BENZIE COUNTY MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:MAPLES-BENZIE COUNTY MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN NHA
Authorized Official - Phone:231-352-9674
Mailing Address - Street 1:210 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9745
Mailing Address - Country:US
Mailing Address - Phone:231-352-9674
Mailing Address - Fax:231-352-5001
Practice Address - Street 1:210 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9745
Practice Address - Country:US
Practice Address - Phone:231-352-9674
Practice Address - Fax:231-352-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI108510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI612085105Medicaid
MI612085105Medicaid