Provider Demographics
NPI:1063419489
Name:CLINTON AREA CARE CENTER, INC
Entity type:Organization
Organization Name:CLINTON AREA CARE CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, LNHA
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:989-224-8936
Mailing Address - Street 1:1101 S SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-8044
Mailing Address - Country:US
Mailing Address - Phone:989-224-8936
Mailing Address - Fax:989-227-8008
Practice Address - Street 1:1101 S SCOTT RD
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-8044
Practice Address - Country:US
Practice Address - Phone:989-224-8936
Practice Address - Fax:989-227-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19-4040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP80436OtherBLUE CARE NETWORK NUMBER
MI2154507Medicaid
MI09585OtherBLUE CROSS BLUE SHIELD
MI09585OtherBLUE CROSS BLUE SHIELD