Provider Demographics
NPI:1588061006
Name:MCCRANIE ACTIVITY CENTER L.L.C.
Entity type:Organization
Organization Name:MCCRANIE ACTIVITY CENTER L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRANIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-795-1480
Mailing Address - Street 1:PO BOX 4085
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-4085
Mailing Address - Country:US
Mailing Address - Phone:517-795-1480
Mailing Address - Fax:517-795-1480
Practice Address - Street 1:1608 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4244
Practice Address - Country:US
Practice Address - Phone:517-795-1480
Practice Address - Fax:517-795-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health