Provider Demographics
NPI:1700891504
Name:U.P. ELDERCARE, LLC
Entity Type:Organization
Organization Name:U.P. ELDERCARE, LLC
Other - Org Name:JOSEPHSON NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:STANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-932-2006
Mailing Address - Street 1:634 E AYER ST
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-2206
Mailing Address - Country:US
Mailing Address - Phone:906-932-2006
Mailing Address - Fax:906-932-1380
Practice Address - Street 1:634 E AYER ST
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-2206
Practice Address - Country:US
Practice Address - Phone:906-932-2006
Practice Address - Fax:906-932-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI274010314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4535772Medicaid
MI4535772Medicaid