Provider Demographics
NPI:1760475123
Name:LAPEER COUNTY MEDICAL CARE FACILITY
Entity type:Organization
Organization Name:LAPEER COUNTY MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NHA
Authorized Official - Phone:810-664-8571
Mailing Address - Street 1:1455 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1151
Mailing Address - Country:US
Mailing Address - Phone:810-664-8571
Mailing Address - Fax:810-664-1677
Practice Address - Street 1:1455 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1151
Practice Address - Country:US
Practice Address - Phone:810-664-8571
Practice Address - Fax:810-664-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI448510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0001455OtherHEALTH PLUS PROVIDER NUMB
MI2085320Medicaid
MI09650OtherBC/BS PROVIDER NUMBER
MI09650OtherBC/BS PROVIDER NUMBER