Provider Demographics
NPI:1659374668
Name:ST. JOSEPH HOME HEALTH & HOSPICE
Entity Type:Organization
Organization Name:ST. JOSEPH HOME HEALTH & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-362-4611
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0239
Mailing Address - Country:US
Mailing Address - Phone:989-362-4611
Mailing Address - Fax:989-362-8771
Practice Address - Street 1:716 GERMAN ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9349
Practice Address - Country:US
Practice Address - Phone:989-362-4611
Practice Address - Fax:989-362-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08737OtherBC/BS HOSPICE
MI1554068Medicaid
MI0E139OtherBC/BS HOME HEALTH
MI2720637Medicaid
MI2720637Medicaid
MI1554068Medicaid