Provider Demographics
NPI:1568455111
Name:NORLITE NURSING CENTERS OF MARQUETTE INC
Entity Type:Organization
Organization Name:NORLITE NURSING CENTERS OF MARQUETTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-9252
Mailing Address - Street 1:701 HOMESTEAD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4438
Mailing Address - Country:US
Mailing Address - Phone:906-228-9252
Mailing Address - Fax:906-228-8344
Practice Address - Street 1:701 HOMESTEAD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4438
Practice Address - Country:US
Practice Address - Phone:906-228-9252
Practice Address - Fax:906-228-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI524040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2151837Medicaid
235367Medicare ID - Type Unspecified