Provider Demographics
NPI:1396724332
Name:IRON RIVER CARE SERVICES INC.
Entity type:Organization
Organization Name:IRON RIVER CARE SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:POSSANZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:NHA
Authorized Official - Phone:906-265-5168
Mailing Address - Street 1:330 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-8452
Mailing Address - Country:US
Mailing Address - Phone:906-265-5168
Mailing Address - Fax:906-265-5571
Practice Address - Street 1:330 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-8452
Practice Address - Country:US
Practice Address - Phone:906-265-5168
Practice Address - Fax:906-265-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI364040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4707250Medicaid
MI235601Medicare ID - Type Unspecified