Provider Demographics
NPI:1982226775
Name:AUGUST WINTER HOUSE, INC.
Entity Type:Organization
Organization Name:AUGUST WINTER HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEBERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-922-2938
Mailing Address - Street 1:10686 WACOUSTA RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8072
Mailing Address - Country:US
Mailing Address - Phone:810-922-2938
Mailing Address - Fax:517-618-7142
Practice Address - Street 1:2111 N LATSON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48855-9750
Practice Address - Country:US
Practice Address - Phone:517-618-7144
Practice Address - Fax:517-618-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1599955OtherUIA