Organization
MAPLE RIDGE LIVING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE KUNKEL 231-839-1011 (ADMINISTRATOR/LICENSEE)
(231) 839-1011
Entity
Organization
Contact information
Practice address
2575 W HOUGHTON LAKE RD, LAKE CITY, MI 49651-8820
(231) 839-1011
Mailing address
2575 W HOUGHTON LAKE RD, P.O. BOX 677, LAKE CITY, MI 49651-8820
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
AL570303169
MI
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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