Provider Demographics
NPI:1629064332
Name:COUNTY OF CASS
Entity Type:Organization
Organization Name:COUNTY OF CASS
Other - Org Name:CASS COUNTY MEDICAL CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TERBORGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-445-3801
Mailing Address - Street 1:23770 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:CASSOPOLIS
Mailing Address - State:MI
Mailing Address - Zip Code:49031-9644
Mailing Address - Country:US
Mailing Address - Phone:269-445-3801
Mailing Address - Fax:
Practice Address - Street 1:23770 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-9644
Practice Address - Country:US
Practice Address - Phone:269-445-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09538OtherBLUE CROSS
MI2085160Medicaid
MI2085160Medicaid