Provider Demographics
NPI:1609869841
Name:GOGEBIC MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:GOGEBIC MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-224-9811
Mailing Address - Street 1:402 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49968-9452
Mailing Address - Country:US
Mailing Address - Phone:906-224-9811
Mailing Address - Fax:906-224-1086
Practice Address - Street 1:402 NORTH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968-9452
Practice Address - Country:US
Practice Address - Phone:906-224-9811
Practice Address - Fax:906-224-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI278510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09614OtherBLUE CROSS/BLUE SHIELD
MI2084190Medicaid
235026Medicare ID - Type Unspecified
235026Medicare Oscar/Certification