Provider Demographics
NPI:1184733685
Name:CHESANING REST HOME INC.
Entity type:Organization
Organization Name:CHESANING REST HOME INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:KEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-845-6602
Mailing Address - Street 1:201 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-1328
Mailing Address - Country:US
Mailing Address - Phone:989-845-6602
Mailing Address - Fax:989-845-4719
Practice Address - Street 1:201 S FRONT ST
Practice Address - Street 2:
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616-1328
Practice Address - Country:US
Practice Address - Phone:989-845-6602
Practice Address - Fax:989-845-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235641314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2150740Medicaid
MI2150740Medicaid