Provider Demographics
NPI:1194711408
Name:BISHOP NOA HOME FOR SENIOR CITIZENS
Entity type:Organization
Organization Name:BISHOP NOA HOME FOR SENIOR CITIZENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-786-5810
Mailing Address - Street 1:2900 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1237
Mailing Address - Country:US
Mailing Address - Phone:906-786-5810
Mailing Address - Fax:906-786-5372
Practice Address - Street 1:2900 3RD AVE S
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1237
Practice Address - Country:US
Practice Address - Phone:906-786-5810
Practice Address - Fax:906-786-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI214010314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2080468Medicaid
MI2080468Medicaid