NPI 1073051264

Creekside Manor

Organisation Exclusive Provider Organization Big Rapids, MI

Practice location

Address: 17460 12 Mile Rd, Big Rapids, MI 49307-9554
Phone: (231) 796-6131

Authorised official

Name: Michael Dean Chaffee
Title: Owner
Phone: (231) 796-6131

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence AM540070004 (MI)

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Registry record

NPI: 1073051264
Entity type: Organization
NPI issued: 7 Feb 2017
Record last updated: 7 Feb 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.