Provider Demographics
NPI:1598700403
Name:TENDERCARE SELECT PROPERTIES INC.
Entity Type:Organization
Organization Name:TENDERCARE SELECT PROPERTIES INC.
Other - Org Name:TENDERCARE GAYLORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-908-8119
Mailing Address - Street 1:209 E PORTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-4200
Mailing Address - Country:US
Mailing Address - Phone:906-635-0020
Mailing Address - Fax:906-635-0212
Practice Address - Street 1:508 RANDOM LN
Practice Address - Street 2:RTE. 4
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9304
Practice Address - Country:US
Practice Address - Phone:989-732-3508
Practice Address - Fax:989-731-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI694020314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2617180Medicaid
MI2617180Medicaid