Provider Demographics
NPI:1700157369
Name:NORTHERN MICHIGAN HOME HEALTH INC
Entity Type:Organization
Organization Name:NORTHERN MICHIGAN HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TYLEE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DECLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-774-4712
Mailing Address - Street 1:W8065 S. US2/141
Mailing Address - Street 2:SUITE E
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801
Mailing Address - Country:US
Mailing Address - Phone:906-774-4712
Mailing Address - Fax:906-774-4713
Practice Address - Street 1:W8065 US 2/141
Practice Address - Street 2:SUITE E
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-9494
Practice Address - Country:US
Practice Address - Phone:906-774-4712
Practice Address - Fax:906-774-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704158708251E00000X
WI3477-31251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health