Provider Demographics
NPI:1851744221
Name:FLATROCK MANOR OF LAPEER
Entity Type:Organization
Organization Name:FLATROCK MANOR OF LAPEER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-459-3831
Mailing Address - Street 1:300 N ELBA RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-8077
Mailing Address - Country:US
Mailing Address - Phone:810-969-4442
Mailing Address - Fax:810-969-4441
Practice Address - Street 1:300 N ELBA RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-8077
Practice Address - Country:US
Practice Address - Phone:810-969-4442
Practice Address - Fax:810-969-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM440337538320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities