Provider Demographics
NPI:1457459059
Name:BARAGA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BARAGA COUNTY MEMORIAL HOSPITAL
Other - Org Name:BARAGA COUNTY HOME CARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:TEMBREULL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:906-524-3321
Mailing Address - Street 1:510 MEMORIAL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946-1138
Mailing Address - Country:US
Mailing Address - Phone:906-524-4663
Mailing Address - Fax:906-524-5663
Practice Address - Street 1:510 MEMORIAL ST
Practice Address - Street 2:SUITE A
Practice Address - City:LANSE
Practice Address - State:MI
Practice Address - Zip Code:49946-1138
Practice Address - Country:US
Practice Address - Phone:906-524-4663
Practice Address - Fax:906-524-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI073512251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08789OtherBLUE CROSS
MI4132062Medicaid
MI08789OtherBLUE CROSS