Provider Demographics
NPI:1699836346
Name:STONE CREEK MANOR
Entity Type:Organization
Organization Name:STONE CREEK MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-687-2855
Mailing Address - Street 1:609 STONE CREEK PASS
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420
Mailing Address - Country:US
Mailing Address - Phone:810-687-2855
Mailing Address - Fax:810-687-2855
Practice Address - Street 1:609 STONE CREEK PASS
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420
Practice Address - Country:US
Practice Address - Phone:810-687-2855
Practice Address - Fax:810-687-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF2502489593747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty