Provider Demographics
NPI:1588650543
Name:NANMAX HEALTH MANAGEMENT INC
Entity type:Organization
Organization Name:NANMAX HEALTH MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:269-857-2141
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MI
Mailing Address - Zip Code:49406-0217
Mailing Address - Country:US
Mailing Address - Phone:269-857-2141
Mailing Address - Fax:269-857-1802
Practice Address - Street 1:243 WILEY ROAD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MI
Practice Address - Zip Code:49406-0217
Practice Address - Country:US
Practice Address - Phone:269-857-2141
Practice Address - Fax:269-857-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4292389Medicaid
MI235447Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER