Provider Demographics
NPI:1760652853
Name:DOUGLAS INVESTMENTS & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DOUGLAS INVESTMENTS & ASSOCIATES, LLC
Other - Org Name:GRACE OF DOUGLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-308-1845
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MI
Mailing Address - Zip Code:49406-0217
Mailing Address - Country:US
Mailing Address - Phone:269-857-2141
Mailing Address - Fax:269-857-1802
Practice Address - Street 1:243 WILEY RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MI
Practice Address - Zip Code:49406-5108
Practice Address - Country:US
Practice Address - Phone:269-857-2141
Practice Address - Fax:269-857-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI034011314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
235447Medicare Oscar/Certification