Provider Demographics
NPI:1487767026
Name:MIDMICHIGAN STRATFORD VILLAGE
Entity type:Organization
Organization Name:MIDMICHIGAN STRATFORD VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRZESINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-633-1486
Mailing Address - Street 1:2121 ROCKWELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-9316
Mailing Address - Country:US
Mailing Address - Phone:989-633-5350
Mailing Address - Fax:
Practice Address - Street 1:2121 ROCKWELL DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-9316
Practice Address - Country:US
Practice Address - Phone:989-633-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDMICHIGAN HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-17
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI564011314000000X
MI1070000265314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09693OtherBCBSM
MI1766453Medicaid
MI1766453Medicaid