Provider Demographics
NPI:1992755375
Name:JHA DOWAGIAC INC
Entity type:Organization
Organization Name:JHA DOWAGIAC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-796-8740
Mailing Address - Street 1:610 UNETA ST
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-1557
Mailing Address - Country:US
Mailing Address - Phone:269-782-3471
Mailing Address - Fax:269-782-1681
Practice Address - Street 1:610 UNETA ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1557
Practice Address - Country:US
Practice Address - Phone:269-782-3471
Practice Address - Fax:269-782-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4453130Medicaid
MI235230Medicare ID - Type Unspecified