# ORION FREDERIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Frederic Nursing and Rehabilitation Community
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528246626
- **Authorized official:** DENNIS LOCKHART (CHIEF ACCOUNTING OFFICER)
- **Authorized official phone:** (614) 416-0600

## Contact information

- **Practice address:** 205 UNITED WAY, FREDERIC, WI 54837-8938
- **Practice address phone:** (715) 327-4297
- **Mailing address:** 5000 HAKES DR, SUITE 600, NORTON SHORES, MI 49441-5574
- **Mailing address phone:** (231) 799-6870

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 3086 | WI | Yes |

## Other

- **Enumeration date:** 01/31/2008
- **Last updated:** 02/13/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 20200400 | — | WI |
| 01 | — | 800059155019 | BCBS PROVIDER CODE | WI |