Provider Demographics
NPI:1376819110
Name:KINDRED SPIRIT
Entity type:Organization
Organization Name:KINDRED SPIRIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE PARENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-686-1710
Mailing Address - Street 1:2320 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1664
Mailing Address - Country:US
Mailing Address - Phone:810-686-1710
Mailing Address - Fax:810-686-8939
Practice Address - Street 1:2320 W DODGE RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1664
Practice Address - Country:US
Practice Address - Phone:810-686-1710
Practice Address - Fax:810-686-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM250273429311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI366-46-3608-C1OtherMEDICARE