Provider Demographics
NPI:1447799648
Name:MICHIGAN IN-HOME PARTNER-II, LLC
Entity Type:Organization
Organization Name:MICHIGAN IN-HOME PARTNER-II, LLC
Other - Org Name:UP HEALTH SYSTEM HOME CARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:STELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:2420 1ST AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1309
Practice Address - Country:US
Practice Address - Phone:906-789-1305
Practice Address - Fax:906-789-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231571Medicare Oscar/Certification