Provider Demographics
NPI:1841006855
Name:HARTUNG, ROBERTA JO
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JO
Last Name:HARTUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10709 VANWERT RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:MI
Mailing Address - Zip Code:49245-9308
Mailing Address - Country:US
Mailing Address - Phone:517-667-2559
Mailing Address - Fax:
Practice Address - Street 1:1493 N COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-9702
Practice Address - Country:US
Practice Address - Phone:517-543-9626
Practice Address - Fax:517-543-3764
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS230418724311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home