Organization
CREEKSIDE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL DEAN CHAFFEE (OWNER)
(231) 796-6131
Entity
Organization
Contact information
Practice address
17460 12 MILE RD, BIG RAPIDS, MI 49307-9554
(231) 796-6131
Mailing address
17460 12 MILE RD, BIG RAPIDS, MI 49307-9554
(231) 796-6131
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
AM540070004
MI
Other
Enumeration date
02/07/2017
Last updated
02/07/2017
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