Basic Information
Provider Information | |||||||||
NPI: | 1174572408 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RHEMA BATTLE CREEK OPERATING LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MANOR OF BATTLE CREEK SKILLED NURSING AND REHABILITATION | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 17515 W NINE MILE RD | ||||||||
Address2: | SUITE 925 | ||||||||
City: | SOUTHFIELD | ||||||||
State: | MI | ||||||||
PostalCode: | 48075 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2485698400 | ||||||||
FaxNumber: | 2485695070 | ||||||||
Practice Location | |||||||||
Address1: | 675 WAGNER DR | ||||||||
Address2: |   | ||||||||
City: | BATTLE CREEK | ||||||||
State: | MI | ||||||||
PostalCode: | 49017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2699696244 | ||||||||
FaxNumber: | 2699624605 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HACK | ||||||||
AuthorizedOfficialFirstName: | SHANNON | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 2485698400 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 134140 | MI | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
No ID Information.