Organization
BARAGA COUNTY MEMORIAL HOSPITAL LTC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P TEMBREULL JR. (ADMINISTRATOR)
(906) 524-3321
Entity
Organization
Contact information
Practice address
770 N MAIN ST, LANSE, MI 49946-1126
(906) 524-3300
(906) 524-5466
Mailing address
770 N MAIN ST, LANSE, MI 49946-1126
(906) 524-3300
(906) 524-5466
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
073010
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09823
BLUE CROSS
MI
01
—
15204
BLUE CROSS
MI
05
—
2000019
—
MI
Enumeration date
09/07/2006
Last updated
04/20/2008
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