Basic Information
| Provider Information | |||||||||
| NPI: | 1659374668 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. JOSEPH HOME HEALTH & HOSPICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 239 | ||||||||
| Address2: | |||||||||
| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487640239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893624611 | ||||||||
| FaxNumber: | 9893628771 | ||||||||
| Practice Location | |||||||||
| Address1: | 716 GERMAN ST | ||||||||
| Address2: | |||||||||
| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487639349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893624611 | ||||||||
| FaxNumber: | 9893628771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BALFOUR | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9893624611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | MI | X | Agencies | Home Health | 251G00000X | MI | X | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 08737 | 01 | MI | BC/BS HOSPICE | OTHER | 1554068 | 05 | MI | MEDICAID | 0E139 | 01 | MI | BC/BS HOME HEALTH | OTHER | 2720637 | 05 | MI | MEDICAID |