Provider Demographics
NPI:1467116236
Name:GORETTI HEALTH LLC
Entity Type:Organization
Organization Name:GORETTI HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMUNTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-429-8305
Mailing Address - Street 1:4303 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2615
Mailing Address - Country:US
Mailing Address - Phone:989-400-5367
Mailing Address - Fax:
Practice Address - Street 1:4303 LINDEN DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2615
Practice Address - Country:US
Practice Address - Phone:989-400-5367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility