Provider Demographics
NPI:1720714645
Name:MCNEILL, DAN
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:GAINES
Mailing Address - State:MI
Mailing Address - Zip Code:48436-8938
Mailing Address - Country:US
Mailing Address - Phone:989-271-6073
Mailing Address - Fax:
Practice Address - Street 1:110 LANSING ST
Practice Address - Street 2:
Practice Address - City:GAINES
Practice Address - State:MI
Practice Address - Zip Code:48436-8938
Practice Address - Country:US
Practice Address - Phone:989-271-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF2504046223104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances