Provider Demographics
NPI:1710362264
Name:DOCKERTY HEALTH CARE SERVICES INC.
Entity Type:Organization
Organization Name:DOCKERTY HEALTH CARE SERVICES INC.
Other - Org Name:WOODLAND TERRACE OF LONGMEADOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/COO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-683-7900
Mailing Address - Street 1:8850 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-9524
Mailing Address - Country:US
Mailing Address - Phone:269-465-7600
Mailing Address - Fax:
Practice Address - Street 1:13 LONGMEADOW VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-7831
Practice Address - Country:US
Practice Address - Phone:269-683-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH110353051310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility