Provider Demographics
NPI:1497183891
Name:EATON COUNTY HEALTH AND REHABILITATION SERVICES
Entity Type:Organization
Organization Name:EATON COUNTY HEALTH AND REHABILITATION SERVICES
Other - Org Name:WELLNESS 101
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-543-2940
Mailing Address - Street 1:530 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1016
Mailing Address - Country:US
Mailing Address - Phone:517-543-2940
Mailing Address - Fax:517-541-0670
Practice Address - Street 1:530 BEECH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1016
Practice Address - Country:US
Practice Address - Phone:517-543-2940
Practice Address - Fax:517-541-0670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EATON COUNTY HEALTH AND REHABILITATION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1278782Medicaid
235027Medicare PIN