Provider Demographics
NPI:1508899238
Name:BRONSON NURSING AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:BRONSON NURSING AND REHABILITATION CENTER
Other - Org Name:BRONSON COMMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:EAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-341-6000
Mailing Address - Street 1:23332 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9703
Mailing Address - Country:US
Mailing Address - Phone:269-283-5200
Mailing Address - Fax:269-283-5215
Practice Address - Street 1:23332 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9703
Practice Address - Country:US
Practice Address - Phone:269-283-5200
Practice Address - Fax:269-283-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI80-4040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2154973Medicaid
MI2154973Medicaid
MI2154973Medicaid