Basic Information
| Provider Information | |||||||||
| NPI: | 1558352070 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITEHILLS HEALTH CARE CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WHITEHILLS HEALTH CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1843 N HAGADORN RD | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488232229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173325061 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1843 N HAGADORN RD | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488232229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173325061 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUNBAR | ||||||||
| AuthorizedOfficialFirstName: | CHAUNCEY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY , TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 6019561576 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 334100 | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1586731 | 05 | MI | MEDICAID |