Organization
BLUE WATER NURSING CENTER
Active
Other names
Evangelical Home - Port Huron
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE G PETROSKEY (CFO)
(313) 836-3499
Entity
Organization
Contact information
Practice address
5635 LAKESHORE RD, FORT GRATIOT, MI 48059-2817
(810) 385-7447
(810) 385-7114
Mailing address
5635 LAKESHORE RD, FORT GRATIOT, MI 48059-2817
(810) 385-7447
(810) 385-7114
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
744060
MI
Other
Enumeration date
01/06/2006
Last updated
08/22/2020
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