DIXIE LODGE (NPI# 1962916692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962916692 |
| Entity Type | Organization |
| Organization Name | DIXIE LODGE |
| Practice Address |
10483 Dixie Hwy Holly MI 48442-9311 |
| Practice Telephone | 8102790027 |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2017-11-16 |
| Authorized Official Name | BRIAN SHERIDAN (OWNER) |
| Authorized Official Telephone | 9892256384 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| Street Address |
10483 DIXIE HWY |
| City | HOLLY |
| State | MI |
| Zip Code | 48442-9311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730317785 | Level 11 Physical Therapy | Clinic/Center | 10483 Dixie Hwy, Holly, MI 48442-9210 | 2009-06-29 |
| 1124658042 | Teresa Renee Finnigan | Speech-Language Pathologist | 10483 Dixie Hwy, Holly, MI 48442-9311 | 2020-01-20 |
| 1851930960 | Andrea Meador | Occupational Therapist | 10483 Dixie Hwy, Holly, MI 48442-9311 | 2020-01-06 |
| 1407491731 | Daniel Pillivant | Physical Therapist | 10483 Dixie Hwy, Holly, MI 48442-9311 | 2019-11-11 |
| 1942845581 | Alicia Ann Gillman Warrick | Physical Therapist | 10483 Dixie Hwy, Holly, MI 48442-9311 | 2019-11-07 |
| 1720622863 | Rachael Fox | Occupational Therapist | 10483 Dixie Hwy, Holly, MI 48442-9311 | 2019-11-01 |
| 1275184145 | Erin Uehara | Physical Therapist | 10483 Dixie Hwy, Holly, MI 48442-9311 | 2019-09-23 |
| 1942868823 | Carley Lukas | Physical Therapist | 10483 Dixie Hwy, Holly, MI 48442-9311 | 2019-06-05 |
| 1679063267 | Casey Polteraitis | Speech-Language Pathologist | 10483 Dixie Hwy, Holly, MI 48442-9311 | 2018-05-18 |
| 1063914646 | Heather Hepper | Physical Therapist | 10483 Dixie Hwy, Holly, MI 48442 | 2018-02-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225527195 | Tina Marie Graves | Intermediate Care Facility, Mentally Retarded | 16065 Fish Lake Rd, Holly, MI 48442 | 2018-05-07 |
| 1831627926 | Emily Marie Ulewicz | Occupational Therapist | 10483 Dixie Highway, Holly, MI 48442 | 2017-06-01 |
| 1427411305 | Amy Jacobs | Occupational Therapist | 10293 S Saginaw Rd, Holly, MI 48442 | 2016-03-30 |
| 1912360892 | Kathryn Ann Garza | Occupational Therapist | 10293 S. Saginaw Rd, Holly, MI 48442 | 2016-03-30 |
| 1730502030 | Jonathan Aldric Potvin | Physical Therapist | 10293 Saginaw Rd, Holly, MI 48442 | 2014-01-23 |
| 1558645572 | Jonathan Boutni | Physical Therapist | 10293 Dixie Highway, Suite 0, Holly, MI 48442 | 2011-10-10 |
| 1770875049 | Donald Mackenzie | Pharmacist | 15242 N Holly Rd, Holly, MI 48442 | 2011-05-05 |
| 1235333295 | Michael Martin Katz | Psychologist | 15249 Fish Lake Rd, Holly, MI 48442 | 2007-06-13 |
| 1629114293 | Fred T Phillips | Dentist | 503 S Broad St, Holly, MI 48442 | 2007-01-30 |
| 1053495648 | Rose Hill Center Inc | Community Based Residential Treatment Facility, Mental Illness | 5130 Rose Hill Blvd, Holly, MI 48442 | 2006-10-24 |
| Find all providers in zip 48442 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
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| 1790397594 | St. Ruth's House of Hope LLC | Custodial Care Facility | 3100 S Electric St, Detroit, MI 48217-1133 | 2020-08-21 |
| 1497364442 | Bolton Brook Manor | Custodial Care Facility | 4554 Thomas Rd, Metamora, MI 48455-9220 | 2020-07-27 |
| 1578171104 | Dream Housing Opportunities LLC | Custodial Care Facility | 304 Wetmore St, Howell, MI 48843-1559 | 2020-07-20 |
| 1194343046 | Creekside Place, Inc. | Custodial Care Facility | 7251 N Briarcliff Knoll Dr, West Bloomfield, MI 48322-4049 | 2020-07-08 |
| 1174140420 | Linda Perrault | Custodial Care Facility | 1551 S Hickory Ridge Rd, Milford, MI 48380-1519 | 2020-07-02 |
| 1063039923 | Visel Afc, Inc. | Custodial Care Facility | 6565 Whitneyville Ave Se, Alto, MI 49302-9027 | 2020-06-26 |
| 1982226775 | August Winter House, Inc. | Custodial Care Facility | 2111 N Latson Rd, Howell, MI 48855-9750 | 2020-05-14 |
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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.