Provider Demographics
NPI:1477083442
Name:MENOMINEE CARE CENTER, LLC
Entity Type:Organization
Organization Name:MENOMINEE CARE CENTER, LLC
Other - Org Name:ATRIUM POST ACUTE CARE OF MENOMINEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-953-0546
Mailing Address - Street 1:1120 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3704
Mailing Address - Country:US
Mailing Address - Phone:201-953-0546
Mailing Address - Fax:
Practice Address - Street 1:501 2ND ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-3203
Practice Address - Country:US
Practice Address - Phone:906-863-9941
Practice Address - Fax:906-853-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2616773Medicaid