Provider Demographics
NPI:1023852936
Name:KELBACH, MARGARET EVA JOLENE
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:EVA JOLENE
Last Name:KELBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8681 COUNTY ROAD 356
Mailing Address - Street 2:
Mailing Address - City:STEPHENSON
Mailing Address - State:MI
Mailing Address - Zip Code:49887-8356
Mailing Address - Country:US
Mailing Address - Phone:906-753-4092
Mailing Address - Fax:207-419-7264
Practice Address - Street 1:W8681 COUNTY ROAD 356
Practice Address - Street 2:
Practice Address - City:STEPHENSON
Practice Address - State:MI
Practice Address - Zip Code:49887-8356
Practice Address - Country:US
Practice Address - Phone:906-753-4092
Practice Address - Fax:207-419-7264
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM5504129723104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances