Provider Demographics
NPI:1548232127
Name:CALHOUN COUNTY MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:CALHOUN COUNTY MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-962-5458
Mailing Address - Street 1:1150 MICHIGAN AVE E
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-6113
Mailing Address - Country:US
Mailing Address - Phone:269-962-5458
Mailing Address - Fax:269-962-7011
Practice Address - Street 1:1150 MICHIGAN AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-6113
Practice Address - Country:US
Practice Address - Phone:269-962-5458
Practice Address - Fax:269-962-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
MI138520314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2085150Medicaid
MI09739OtherBLUE CROSS PROVIDER NUMBE
MI09739OtherBLUE CROSS PROVIDER NUMBE