Provider Demographics
NPI:1215934534
Name:TUSCOLA COUNTY MEDICAL CARE FACILITY
Entity type:Organization
Organization Name:TUSCOLA COUNTY MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGOT
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:989-673-4117
Mailing Address - Street 1:1285 CLEAVER RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9241
Mailing Address - Country:US
Mailing Address - Phone:989-673-4117
Mailing Address - Fax:989-673-6665
Practice Address - Street 1:1285 CLEAVER RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9241
Practice Address - Country:US
Practice Address - Phone:989-673-4117
Practice Address - Fax:989-673-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI798510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2085188Medicaid
MI09653OtherINSURANCE ID BCBSM
MI1222890001OtherDMERC ID - ADMINISTAR
MI1222890001OtherDMERC ID - ADMINISTAR