Provider Demographics
NPI:1245453786
Name:PORTAGE HEALTH HOME SERVICES, INC.
Entity type:Organization
Organization Name:PORTAGE HEALTH HOME SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-483-1170
Mailing Address - Street 1:200 MICHIGAN ST STE 328
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1448
Mailing Address - Country:US
Mailing Address - Phone:906-483-1170
Mailing Address - Fax:906-487-7487
Practice Address - Street 1:200 MICHIGAN ST STE 328
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1448
Practice Address - Country:US
Practice Address - Phone:906-483-1170
Practice Address - Fax:906-487-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty