CHARLEVOIX NURSING HOME CORPORATION (NPI# 1508962069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508962069 |
| Entity Type | Organization |
| Organization Name | CHARLEVOIX NURSING HOME CORPORATION |
| Other Organization Name | BOULDER PARK TERRACE |
| Practice Address |
14676 W Upright St Charlevoix MI 49720-1201 |
| Practice Telephone | 2315471005 |
| Mailing Telephone | 2315471005 |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2017-08-28 |
| Authorized Official Name | MR. DAVID BELLAMY (CFO) |
| Authorized Official Telephone | 2314874094 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 235526 | MI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 2896882 | 05 |
| Other Name | Type Code |
|---|---|
| Boulder Park Terrace | Doing Business As Name - Organization |
| Street Address |
14676 W UPRIGHT ST |
| City | CHARLEVOIX |
| State | MI |
| Zip Code | 49720-1201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265933014 | Adam John Tsaloff | Physical Therapist | 14676 W Upright St, Charlevoix, MI 49720-1201 | 2018-02-27 |
| 1558862524 | Robert Stout | Physical Therapist | 14676 W Upright St, Charlevoix, MI 49720-1201 | 2018-02-26 |
| 1164923926 | Michonne Marie Palmer | Occupational Therapist | 14676 W Upright St, Charlevoix, MI 49720-1201 | 2018-02-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609477488 | Munson Healthcare Charlevoix Hospital | Urology | 11695 Park Ave, Suite A, Charlevoix, MI 49720 | 2020-11-06 |
| 1215587498 | Amanda Evans | Dietitian, Registered | 09210 North Pointe Woods Drive, Charlevoix, MI 49720 | 2019-09-18 |
| 1508229980 | Charlevoix Physicians Clinic | Specialist | 14709 W. Upright, Charlevoix, MI 49720 | 2016-04-01 |
| 1881014348 | Tracy Skinner | Social Worker | 220 W. Garfield Ave, Charlevoix, MI 49720 | 2014-04-23 |
| 1720414097 | Jennifer Jean Swenor | Occupational Therapist | 10270 Burnett Rd, Charlevoix, MI 49720 | 2013-09-18 |
| 1801171863 | Leslie Lukins | Pharmacist | 1500 Bridge Street, Charlevoix, MI 49720 | 2011-10-20 |
| 1164670949 | Northwest Michigan Community Health Agency | Hospice Care, Community Based | 220 W Garfield Street, Charlevoix, MI 49720 | 2008-09-04 |
| 1275722191 | Robert Dennis Cook | Pharmacist | 301 Bridge Street, Charlevoix, MI 49720 | 2007-10-16 |
| 1629191648 | Susan Mary Killam | Nurse Practitioner | Northwest Michigan Community Health Agency, 220 W. Garfield Street, Charlevoix, MI 49720 | 2007-04-06 |
| 1851410153 | Joelle M Beaudoin | Specialist/Technologist | 06510 M-66 N, Charlevoix, MI 49720 | 2007-03-28 |
| Find all providers in zip 49720 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669906475 | Arinas Senior Care LLC | Nursing Facility/Intermediate Care Facility | 6861 N Clunbury Rd, West Bloomfield, MI 48322-4316 | 2017-04-18 |
| 1063963304 | Susan Traut | Nursing Facility/Intermediate Care Facility | 1 Dunlap Cir, Oxford, MI 48371-5206 | 2016-10-21 |
| 1700258225 | Danielle Shilling | Nursing Facility/Intermediate Care Facility | 1011 E Central Rd, Quincy, MI 49082-9725 | 2015-10-23 |
| 1952798076 | Rehabilitation Masters PC | Nursing Facility/Intermediate Care Facility | 20331 Mauer St, Saint Clair Shores, MI 48080-1773 | 2015-04-16 |
| 1588055701 | Nextstep Billing and Payroll | Nursing Facility/Intermediate Care Facility | 3201 University Dr, Suite 250, Auburn Hills, MI 48326-2394 | 2015-02-10 |
| 1679993489 | Partners In Parenting | Nursing Facility/Intermediate Care Facility | 8235 Freda St, Detroit, MI 48204-3127 | 2014-04-18 |
| 1528491438 | Altum Care Homes | Nursing Facility/Intermediate Care Facility | 23408 Plum Hollow St, Southfield, MI 48033-3275 | 2013-08-14 |
| 1801233465 | Wellness Group Home Care LLC | Nursing Facility/Intermediate Care Facility | 26300 Ford Rd Ste 421, Dearborn Heights, MI 48127-2854 | 2013-05-22 |
| 1548537103 | Rest Haven Homes Inc | Nursing Facility/Intermediate Care Facility | 1424 Union Ave Ne, Grand Rapids, MI 49505-5197 | 2011-11-28 |
| 1649568726 | Aa Home Health Care, LLC | Nursing Facility/Intermediate Care Facility | 55 N Pond Dr Ste 1, Walled Lake, MI 48390-3080 | 2011-07-11 |
| Find all providers with the same taxonomy | ||||
| City | CHARLEVOIX |
| Zip Code | 49720 |
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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.