Provider Demographics
NPI:1588655849
Name:FERGUSON CONVALESCENT HOME, INC.
Entity Type:Organization
Organization Name:FERGUSON CONVALESCENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-664-6611
Mailing Address - Street 1:239 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2426
Mailing Address - Country:US
Mailing Address - Phone:810-664-6611
Mailing Address - Fax:810-664-8633
Practice Address - Street 1:239 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2426
Practice Address - Country:US
Practice Address - Phone:810-664-6611
Practice Address - Fax:810-664-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI44-4010313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2153214Medicaid
MI23E089Medicare Oscar/Certification
235654Medicare Oscar/Certification