CROCKERY CREEK ELDER CARE, INC (NPI# 1356740245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356740245 |
| Entity Type | Organization |
| Organization Name | CROCKERY CREEK ELDER CARE, INC |
| Practice Address |
12291 Crockery Creek Dr. Ravenna MI 49451 |
| Mailing Address |
12291 Crockery Creek Dr Ravenna MI 49451-8831 |
| Practice Telephone | 2318538452 |
| Practice Fax Number | 2318538492 |
| Mailing Telephone | 2318538452 |
| Mailing Fax Number | 2318538492 |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-18 |
| Authorized Official Name | MR. GARY LEE MARSMAN (OWNER - PRESIDENT) |
| Authorized Official Telephone | 2312062265 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AF610238757 | MI | Nursing & Custodial Care Facilities |
| Street Address |
12291 CROCKERY CREEK DR. |
| City | RAVENNA |
| State | MI |
| Zip Code | 49451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114251139 | Alisha Lewise Warner | Nurse's Aide | 155 S. Trent Rd., Ravenna, MI 49451 | 2009-09-23 |
| 1346413309 | Kelley Marie Young | Nurse Practitioner | 12520 Crockery Creek Drive, Ravenna, MI 49451 | 2008-04-10 |
| 1508084310 | Bonnie Jean Pline | Family Medicine | 1042 S. Ravenna Rd., Ravenna, MI 49451 | 2007-04-24 |
| 1083619936 | Timothy L Beechnau | Family Medicine | 12520 Crockery Creek Dr., Ravenna, MI 49451 | 2005-06-16 |
| 1417279407 | Apple Family Medicine, P.l.c. | Clinic/Center | 1042 S Ravenna Rd, Ravenna, MI 49451 | 2010-02-18 |
| 1497928469 | Ravenna Family Practice, P.C. | Family Medicine | 12520 Crockery Creek Dr., Ravenna, MI 49451 | 2008-04-10 |
| 1063455129 | Craig R Cameron Dds Plc | Dentist | 12374 Stafford Street, Ravenna, MI 49451-0204 | 2006-06-14 |
| 1083809917 | Craig Robert Cameron | Dentist | 12374 Stafford Street, Ravenna, MI 49451-0204 | 2007-09-13 |
| 1023287836 | Robert D & Cindy L Douglas | Technician/Technologist | 12412 Stafford, Ravenna, MI 49451-0307 | 2008-02-26 |
| 1164784724 | Nicholas S Beechnau | Family Medicine | 12520 Crockery Creek Dr, Ravenna, MI 49451-5100 | 2012-06-11 |
| Find all providers in zip 49451 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
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| 1457644577 | Seneca Sunrise LLC | Assisted Living Facility | 710 Grand Ave, Ravenna, NE 68869-1100 | 2011-05-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.