Provider Demographics
NPI:1396723508
Name:EVANGELICAL HOMES OF MICHIGAN
Entity type:Organization
Organization Name:EVANGELICAL HOMES OF MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-295-9292
Mailing Address - Street 1:440 W RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1184
Mailing Address - Country:US
Mailing Address - Phone:734-429-9401
Mailing Address - Fax:734-429-0183
Practice Address - Street 1:440 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1184
Practice Address - Country:US
Practice Address - Phone:734-429-9401
Practice Address - Fax:734-429-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI814120314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI602084019Medicaid