Provider Demographics
NPI:1457354268
Name:COUNTY OF ALLEGAN
Entity Type:Organization
Organization Name:COUNTY OF ALLEGAN
Other - Org Name:ALLEGAN COUNTY MEDICAL CARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TURCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:269-673-2102
Mailing Address - Street 1:3265 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9511
Mailing Address - Country:US
Mailing Address - Phone:269-673-2102
Mailing Address - Fax:269-673-6199
Practice Address - Street 1:3265 122ND AVE
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:269-673-2102
Practice Address - Fax:269-673-6199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ALLEGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI038510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09517OtherBCBS PROVIDER NUMBER
MI2085132Medicaid
MI2085132Medicaid